Pre-procedural right ventricular ejection fraction <45% by CT was associated with a higher risk of 1-year mortality or heart failure hospitalization after TTVR (HR 2.99; 95% CI 1.65-5.41; P=0.001).
Cohort (n=157)
Does pre-procedural right ventricular dysfunction (CT-RVEF <45%) increase the risk of adverse clinical outcomes in patients undergoing transcatheter tricuspid valve repair?
Pre-procedural assessment of right ventricular ejection fraction by cardiac CT identifies patients at higher risk of mortality and heart failure hospitalization after transcatheter tricuspid valve repair.
Effect estimate: HR 2.99 (95% CI 1.65-5.41)
p-value: p=0.001
AIMS: The role of right ventricular function in patients undergoing transcatheter tricuspid valve repair (TTVR) is poorly understood. This study investigated the association of right ventricular ejection fraction (RVEF) assessed by cardiac computed tomography (CCT) with clinical outcomes in patients undergoing TTVR. METHODS AND RESULTS: We retrospectively assessed three-dimensional (3D) RVEF by using pre-procedural CCT images in patients undergoing TTVR. RV dysfunction was defined as a CT-RVEF of <45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within 1 year after TTVR. Of 157 patients, 58 (36.9%) presented with CT-RVEF <45%. Procedural success and in-hospital mortality were comparable between patients with CT-RVEF <45% and ≥45%. However, CT-RVEF of <45% was associated with a higher risk of the composite outcome (hazard ratio: 2.99; 95% confidence interval: 1.65-5.41; P = 0.001), which had an additional value beyond two-dimensional echocardiographic assessments of RV function to stratify the risk of the composite outcome. In addition, patients with CT-RVEF ≥45% exhibited the association of procedural success (i.e. residual tricuspid regurgitation of ≤2+ at discharge) with a decreased risk of the composite outcome, while this association was attenuated in those with CT-RVEF <45% (P for interaction = 0.035). CONCLUSION: CT-RVEF is associated with the risk of the composite outcome after TTVR, and a reduced CT-RVEF might attenuate the prognostic benefit of TR reduction. The assessment of 3D-RVEF by using CCT may refine the patient selection for TTVR.
Tanaka et al. (Fri,) conducted a cohort in Transcatheter tricuspid valve repair (n=157). CT-RVEF <45% vs. CT-RVEF ≥45% was evaluated on Composite of all-cause mortality and hospitalization due to heart failure within 1 year after TTVR (HR 2.99, 95% CI 1.65-5.41, p=0.001). Pre-procedural right ventricular ejection fraction <45% by CT was associated with a higher risk of 1-year mortality or heart failure hospitalization after TTVR (HR 2.99; 95% CI 1.65-5.41; P=0.001).