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Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation

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Abstract

Aims

Tricuspid regurgitation (TR) in patients with mitral valve disease is associated with poor outcome and mortality. Only limited data on the impact of TR on functional outcome and survival in patients undergoing MitraClip procedures are available.

Methods and results

261 patients (mean age 76.6 ± 10, EuroScore 15.9 ± 15.1%) with symptomatic mitral regurgitation (MR) (75.2% functional MR) undergoing MitraClip procedure were included and followed for 721 ± 19.4 days. At baseline 54.7% presented with TR grade 0/I, 29.5% with grade II, 13.4% with grade III and 2.3% with grade IV. When dividing groups according to baseline TR grades, follow-up (FU)-NYHA class was significantly improved only in patients with TR ≤ II (p = 0.05). FU-6-min walking distance increased significantly in the overall cohort (p = 0.05), in patients with TR ≤ II (p = 0.007), but not in patients with TR > II (p = 0.4). Moreover, FU-NT-pro-BNP levels were higher in patients with TR > II (p = 0.05), compared to patients with TR ≤ II. There was a higher mortality according to baseline TR > II and multivariate Cox regression revealed TR > II as the strongest independent predictor for mortality (hazard ratio 2.04).

Conclusions

Concomitant TR at baseline negatively influences functional outcome and mortality in patients undergoing MitraClip procedures. Our results underline the need for dedicated interventional strategies for the treatment of TR in patients with symptomatic MR.

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Abbreviations

EROA:

Effective regurgitant orifice area

LV:

Left ventricle/ventricular

LVEDV:

Left ventricular end diastolic volume

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

MV:

Mitral valve

PISA:

Proximal isovelocity surface area

RV:

Right ventricle

TR:

Tricuspid regurgitation

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    Authors and Affiliations

    1. Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

      Robert Schueler, Can Öztürk, Jan-Malte Sinning, Nikos Werner, Christoph Hammerstingl & Georg Nickenig

    2. Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany

      Armin Welz

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    1. Robert Schueler
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    Correspondence to Robert Schueler.

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    The study was not funded.

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    R. Schueler and C. Öztürk contributed equally to the manuscript.

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    Schueler, R., Öztürk, C., Sinning, JM. et al. Impact of baseline tricuspid regurgitation on long-term clinical outcomes and survival after interventional edge-to-edge repair for mitral regurgitation. Clin Res Cardiol 106, 350–358 (2017). https://doi.org/10.1007/s00392-016-1062-1

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