TY - JOUR
T1 - Prognostic Value of Pulmonary Hypertension, Right Ventricular Function and Tricuspid Regurgitation on Mortality After Transcatheter Mitral Valve Repair
T2 - A Systematic Review and Meta-Analysis
AU - Meijerink, Frank
AU - de Witte, Samme M.
AU - Limpens, Jacqueline
AU - de Winter, Robbert J.
AU - Bouma, Berto J.
AU - Baan, Jan
N1 - Funding Information: JB receives an unrestricted research grant from Abbott Vascular . None of the remaining authors declare any conflict of interest. Publisher Copyright: © 2021 The Author(s)
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Pulmonary hypertension (PH), right ventricular (RV) dysfunction, and tricuspid regurgitation (TR) are commonly present in patients with mitral regurgitation (MR) and known to impair prognosis. This systematic review and meta-analysis aimed to determine the prognostic value of PH, RV function, and TR on mortality after transcatheter mitral valve repair (TMVR). Methods: A systematic search was performed to identify studies investigating PH, RV function, or TR in patients who underwent TMVR. Studies were included for pooled analysis if hazard ratios (HR) for all-cause mortality were given. Results: A total of 8,672 patients from 21 selected studies were included (PH, 11 studies; RV function, nine studies; TR, 10 studies). Mean follow-up was 2.7±1.6 years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR 1.70 95% CI 1.00–2.87; per 10 mmHg increase in systolic PAP: HR 1.17 95% CI 1.07–1.29), RV function (dichotomised: HR 1.86 95% CI 1.45–2.38; per 5 mm decrease in TAPSE: HR 1.18 95% CI 0.97–1.43) and TR (HR 1.51 95% CI 1.28–1.79) indicated a significant association. Conclusion: Prognosis after TMVR is worse in patients with significant MR when concomitant PH, RV dysfunction, or TR are present. Careful assessment of these parameters should therefore precede clinical decision-making for TMVR. The current results encourage investigation into whether (1) intervention at an earlier stage of MR reduces incidence of PH, RV dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can improve clinical outcome and prognosis for these patients.
AB - Background: Pulmonary hypertension (PH), right ventricular (RV) dysfunction, and tricuspid regurgitation (TR) are commonly present in patients with mitral regurgitation (MR) and known to impair prognosis. This systematic review and meta-analysis aimed to determine the prognostic value of PH, RV function, and TR on mortality after transcatheter mitral valve repair (TMVR). Methods: A systematic search was performed to identify studies investigating PH, RV function, or TR in patients who underwent TMVR. Studies were included for pooled analysis if hazard ratios (HR) for all-cause mortality were given. Results: A total of 8,672 patients from 21 selected studies were included (PH, 11 studies; RV function, nine studies; TR, 10 studies). Mean follow-up was 2.7±1.6 years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR 1.70 95% CI 1.00–2.87; per 10 mmHg increase in systolic PAP: HR 1.17 95% CI 1.07–1.29), RV function (dichotomised: HR 1.86 95% CI 1.45–2.38; per 5 mm decrease in TAPSE: HR 1.18 95% CI 0.97–1.43) and TR (HR 1.51 95% CI 1.28–1.79) indicated a significant association. Conclusion: Prognosis after TMVR is worse in patients with significant MR when concomitant PH, RV dysfunction, or TR are present. Careful assessment of these parameters should therefore precede clinical decision-making for TMVR. The current results encourage investigation into whether (1) intervention at an earlier stage of MR reduces incidence of PH, RV dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can improve clinical outcome and prognosis for these patients.
KW - Predictors
KW - Prognosis
KW - Pulmonary hypertension
KW - Right ventricular function
KW - Tricuspid
UR - http://www.scopus.com/inward/record.url?scp=85122963500&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hlc.2021.11.017
DO - https://doi.org/10.1016/j.hlc.2021.11.017
M3 - Article
C2 - 35058141
SN - 1443-9506
VL - 31
SP - 696
EP - 704
JO - Heart, lung & circulation
JF - Heart, lung & circulation
IS - 5
ER -