Abstract 956 Right Ventricular Cardiac Power Output Predicts Mortality after Transcatheter Edge-to-Edge-Repair for Severe Tricuspid Valve Regurgitation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Right Ventricular Cardiac Power Output Predicts Mortality after Transcatheter Edge-to-Edge-Repair for Severe Tricuspid Valve Regurgitation
K. Diehl¹, R. Osteresch¹, A. Ben Ammar¹, P. Dierks¹, A. Fach¹, C. Frerker², I. Eitel², H. Wienbergen¹, R. Hambrecht¹
¹Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen; ²Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck;
Background: Transcatheter edge-to-edge repair (TEER) for severe tricuspid regurgitation (TR) emerged as a novel treatment option for patients (pts.) not amenable for surgery. However, knowledge regarding independent risk factors for worse prognosis is rarely available. Objective: The study sought to investigate the utility of right ventricular cardiac power output (RV-CPO) in predicting mortality in pts. with severe symptomatic TR undergoing TEER. Methods: Consecutive patients with severe TR who underwent TEER between 08/2020 to 08/2021 were included and followed prospectively. Baseline clinical and invasive hemodynamic variables, changes in echocardiographic parameters and New York Heart Association (NYHA) functional class, periprocedural and in-hospital major adverse events were assessed. Primary endpoint was defined as all-cause mortality during a median follow-up period of 9±5 months. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for all-cause mortality. RV-CPO was calculated as: [Cardiac output * mean pulmonary pressure] * K (conversion factor 2.22 × 10-3) = W. Receiver operator characteristic (ROC) analysis was used to determine discriminative capacity of RV-CPO. The prognostic value of RV-CPO threshold was tested using Kaplan-Meier analysis. Results: 49 pts. (median age 79,8±8 years, 53,1% women) at high operative risk (LogEuro-Score 17,7±13%) underwent TEER for severe TR. In-hospital, 30-day and long-term follow-up rates of all-cause mortality were 0%, 4,1% and 26,5%, respectively. Pts. who have died presented higher RV-CPO (0,27±0,12W vs. 0,38±0,16W; p=0,017). ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a threshold of 0.27W for RV-CPO (sensitivity 80%, specificity 61,6%, area under the curve 0.73 [0.56-0.9]; p=0.01). Kaplan-Meier analysis revealed significant lower event-free survival in pts. with RV-CPO >0.27W (50% vs. 12,5%; log-rank p=0.025). In Cox regression analysis, NT-proBNP (HR 5.1; CI 2.1 - 12.6; p<0.001), age (HR 0.90; CI 0.81 - 0.99; p=0.029) and RV-CPO (HR 9.4; CI 2.1- 41.4; p=0.003) were independent predictors for all-cause mortality. Conclusions: RV-CPO is associated with all-cause mortality among pts. undergoing TEER. Therefore, this hemodynamic predictor might be useful in risk stratification of TEER candidates with severe TR. $C:\Users\roll\Desktop\Abstract_Grafiken\2021-11-24_11h01_59.jpg$ $C:\Users\roll\Desktop\Abstract_Grafiken\2021-11-24_11h03_13.jpg$
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