PMID- 33582067 OWN - NLM STAT- MEDLINE DCOM- 20210827 LR - 20240117 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 14 IP - 4 DP - 2021 Apr TI - Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. PG - 768-778 LID - S1936-878X(20)31106-2 [pii] LID - 10.1016/j.jcmg.2020.12.015 [doi] AB - OBJECTIVES: This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR). BACKGROUND: Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD. METHODS: Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio. RESULTS: Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007). CONCLUSIONS: RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Karam, Nicole AU - Karam N AD - Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France. FAU - Stolz, Lukas AU - Stolz L AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Orban, Mathias AU - Orban M AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany; Munich Heart Alliance, Partner Site, German Center for Cardiovascular Disease, Munich, Germany. FAU - Deseive, Simon AU - Deseive S AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Praz, Fabien AU - Praz F AD - Universitatsklinik fur Kardiologie, Inselspital Bern, Switzerland. FAU - Kalbacher, Daniel AU - Kalbacher D AD - Klinik fur Kardiologie, Universitares Herz und Gefasszentrum Hamburg, Hamburg, Germany. FAU - Westermann, Dirk AU - Westermann D AD - Klinik fur Kardiologie, Universitares Herz und Gefasszentrum Hamburg, Hamburg, Germany. FAU - Braun, Daniel AU - Braun D AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Nabauer, Michael AU - Nabauer M AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Neuss, Michael AU - Neuss M AD - Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany. FAU - Butter, Christian AU - Butter C AD - Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany. FAU - Kassar, Mohammad AU - Kassar M AD - Universitatsklinik fur Kardiologie, Inselspital Bern, Switzerland. FAU - Petrescu, Aniela AU - Petrescu A AD - Zentrum fur Kardiologie, Johannes Gutenberg-Universitat, Mainz, Germany. FAU - Pfister, Roman AU - Pfister R AD - Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany. FAU - Iliadis, Christos AU - Iliadis C AD - Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany. FAU - Unterhuber, Matthias AU - Unterhuber M AD - Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. FAU - Park, Sang-Don AU - Park SD AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany. FAU - Thiele, Holger AU - Thiele H AD - Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. FAU - Baldus, Stephan AU - Baldus S AD - Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany. FAU - von Bardeleben, Ralph Stephan AU - von Bardeleben RS AD - Zentrum fur Kardiologie, Johannes Gutenberg-Universitat, Mainz, Germany. FAU - Blankenberg, Stefan AU - Blankenberg S AD - Klinik fur Kardiologie, Universitares Herz und Gefasszentrum Hamburg, Hamburg, Germany. FAU - Massberg, Steffen AU - Massberg S AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany; Munich Heart Alliance, Partner Site, German Center for Cardiovascular Disease, Munich, Germany. FAU - Windecker, Stephan AU - Windecker S AD - Universitatsklinik fur Kardiologie, Inselspital Bern, Switzerland. FAU - Lurz, Philipp AU - Lurz P AD - Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. FAU - Hausleiter, Jorg AU - Hausleiter J AD - Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, Munich, Germany; Munich Heart Alliance, Partner Site, German Center for Cardiovascular Disease, Munich, Germany. Electronic address: joerg.hausleiter@med.uni-muenchen.de. LA - eng PT - Journal Article DEP - 20210210 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 SB - IM CIN - JACC Cardiovasc Imaging. 2021 Apr;14(4):779-781. PMID: 33582066 MH - *Cardiac Surgical Procedures MH - Humans MH - *Mitral Valve Insufficiency/diagnostic imaging/etiology/surgery MH - Predictive Value of Tests MH - Treatment Outcome MH - *Ventricular Dysfunction, Right/diagnostic imaging/etiology/surgery OTO - NOTNLM OT - edge-to-edge repair OT - outcome OT - right ventricular function OT - right ventricular-to-pulmonary artery coupling OT - secondary mitral regurgitation OT - tricuspid regurgitation COIS- Funding Support and Author Disclosures Dr. Karam is a consultant for Abbott Vascular. Dr. Orban has received speaker fees from Abbott Vascular. Dr. Windecker has received research and educational grants from Abbott, Amgen, Bristol Myers Squibb, Bayer, Boston Scientific, Biotronik, CSL, Medtronic, Edwards Lifesciences, Sinomed, and Polares. Dr. Pfister has received financial support for attending symposia by Abbot Vascular. Dr. von Bardeleben has received speaker fees from Abbott Vascular and Edwards Lifesciences. Dr. Hausleiter has received research support and speaker honoraria from Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. EDAT- 2021/02/15 06:00 MHDA- 2021/08/28 06:00 CRDT- 2021/02/14 20:26 PHST- 2020/08/11 00:00 [received] PHST- 2020/11/24 00:00 [revised] PHST- 2020/12/07 00:00 [accepted] PHST- 2021/02/15 06:00 [pubmed] PHST- 2021/08/28 06:00 [medline] PHST- 2021/02/14 20:26 [entrez] AID - S1936-878X(20)31106-2 [pii] AID - 10.1016/j.jcmg.2020.12.015 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2021 Apr;14(4):768-778. doi: 10.1016/j.jcmg.2020.12.015. Epub 2021 Feb 10.