Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure
- PMID: 33309317
- DOI: 10.1016/j.jcin.2020.09.033
Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure
Abstract
Objectives: This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality.
Background: Severe tricuspid regurgitation (TR) is associated with high mortality. TTVR effectively alleviates heart failure symptoms, but comprehensive hemodynamic characterization of patients undergoing TTVR is currently lacking.
Methods: This international, multicenter study included 236 patients undergoing TTVR. Data from clinical assessment, echocardiography, intraprocedural right heart catheterization, and noninvasive cardiac output measurement were analyzed. Hemodynamic predictors for mortality were identified using linear Cox regression analysis and were used for stratification of patients with subsequent analysis of survival time.
Results: Patients (median age 78 years, 53% women) were symptomatic (89% in New York Heart Association functional class III or IV) because of severe TR (grade ≥3+ in 100%). TTVR significantly reduced TR at discharge (grade ≥3+ in 16%; p < 0.001), with a corresponding 19% reduction of the right atrial v wave (21 mm Hg vs. 16 mm Hg; p < 0.001) and an improvement in cardiac output (from 3.5 to 4.0 l/min; p < 0.01). Invasive mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, and right ventricular stroke work were significant predictors of 1-year mortality (p < 0.05 for all). Hemodynamic stratification by mean pulmonary artery pressure and transpulmonary gradient best predicted 1-year survival (p < 0.001). Although patients with pre-capillary dominant pulmonary hypertension showed an unfavorable prognosis (1-year survival 38%), patients without or with post-capillary pulmonary hypertension had favorable outcome (1-year survival 92% or 78%, respectively).
Conclusions: Invasive assessment of cardiopulmonary hemodynamic status predicts survival after TTVR. Invasive hemodynamic characterization may help identify patients profiting most from TTVR.
Keywords: edge-to-edge repair; heart failure; right heart hemodynamics; transcatheter therapy; tricuspid regurgitation.
Copyright © 2021. Published by Elsevier Inc.
Conflict of interest statement
Author Disclosures Dr. Braun has received speaker honoraria from Abbott Vascular. Dr. Fam is a consultant for Edwards Lifesciences; and has received speaker honoraria from Abbott Vascular. Dr. von Bardeleben has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. Dr. Lurz has received research grants from Edwards Lifesciences and Abbott Vascular; and is a consultant to Edwards Lifesciences and Abbott Vascular. Dr. Hausleiter has received speaker honoraria and research support from and serves as a consultant for Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Comment in
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Right-Heart Catheterization of Severe Functional Tricuspid Regurgitation: A Step Forward in Reducing its Pervasive Undertreatment?JACC Cardiovasc Interv. 2021 Jan 11;14(1):39-40. doi: 10.1016/j.jcin.2020.10.048. Epub 2020 Dec 19. JACC Cardiovasc Interv. 2021. PMID: 33309315 No abstract available.