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Meta-Analysis
. 2021 Dec;8(6):4988-4996.
doi: 10.1002/ehf2.13558. Epub 2021 Sep 22.

Right ventricular dysfunction and tricuspid regurgitation in functional mitral regurgitation

Vien T Truong  1   2 , Tam N M Ngo  1   3 , Jan Mazur  4 , Hoai T M Nguyen  3 , Thuy T M Pham  5 , Cassady Palmer  1 , Khanh N P Pham  6 , Hoang T Phan  3   7 , Kwan S Lee  8 , Marwin Bannehr  9 , Christian Butter  9 , Takayuki Gyoten  10 , Eugene S Chung  1
Affiliations
Meta-Analysis

Right ventricular dysfunction and tricuspid regurgitation in functional mitral regurgitation

Vien T Truong et al. ESC Heart Fail. 2021 Dec.

Abstract

Aim: The objective of this study was to investigate the prognostic importance of right ventricular dysfunction (RVD) and tricuspid regurgitation (TR) in patients with moderate-severe functional mitral regurgitation (FMR) receiving MitraClip procedure. RVD and TR grade are associated with cardiovascular mortality in the general population and other cardiovascular diseases. However, there are limited data from observational studies on the prognostic significance of RVD and TR in FMR receiving MitraClip procedure.

Methods and results: A systemic review and meta-analysis were performed using MEDLINE, Scopus, and Embase to assess the prognostic value of RVD and TR grade for mortality in patients with functional mitral regurgitation (FMR) receiving MitraClip procedure. Hazard ratios were extracted from multivariate models reporting on the association of RVD and TR with mortality and described as pooled estimates with 95% confidence intervals. A total of eight non-randomized studies met the inclusion criteria with seven studies having at least 12 months follow-up with a mean follow-up of 20.9 months. Among the aforementioned studies, a total of 1112 patients (71.5% being male) were eligible for being included in our meta-analysis with an overall mortality rate of 28.4% (n = 316). Of the enrolled patients, RVD was present in 46.1% and moderate-severe TR in 29.2%. RVD was significantly associated with mortality compared to normal RV function (HR, 1.79, 95% CI, 1.39-2.31, P < 0.001, I2 = 0). Patients with moderate-severe TR showed increased risk of mortality compared with those in the none-mild TR group (HR, 1.61. 95% CI, 1.11-2.33, P = 0.01, I2 = 14).

Conclusions: This meta-analysis demonstrates the prognostic importance of RVD and TR grade in predicting all-cause mortality in patients with significant FMR. RV function and TR parameters may therefore be useful in the risk stratification of patients with significant FMR undergoing MitraClip procedure.

Keywords: Functional mitral regurgitation; Meta-analysis; MitraClip procedure; Mortality; Right ventricular dysfunction; Tricuspid regurgitation.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study design. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flowchart demonstrating study selection process.
Figure 2
Figure 2
The forest plot displays the hazard ratio and 95% confidence intervals (CIs) for difference between patients with and without right ventricular dysfunction. Square markers indicate hazard ratios; horizontal lines, the 95% CIs, with marker size reflecting the statistical weight of the study using random‐effects meta‐analysis. The diamond marker represents the overall hazard ratio and 95% CI for the outcome of interest.
Figure 3
Figure 3
The forest plot displays the hazard ratio and 95% confidence intervals (CIs) for difference between patients with and without moderate–severe tricuspid regurgitation. Square markers indicate hazard ratios; horizontal lines, the 95% CIs, with marker size reflecting the statistical weight of the study using random‐effects meta‐analysis. The diamond marker represents the overall hazard ratio and 95% CI for the outcome of interest.
Figure 4
Figure 4
Funnel plot of publications included in the meta‐analysis for right ventricular dysfunction.
Figure 5
Figure 5
Funnel plot of publications included in the meta‐analysis for tricuspid regurgitation.
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