Abstract 1079 Prognostic Impact of Tricuspid Regurgitation Improvement after Transcatheter Mitral Valve Replacement: Results from an International Multicenter Registry

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Prognostic Impact of Tricuspid Regurgitation Improvement after Transcatheter Mitral Valve Replacement: Results from an International Multicenter Registry
S. Ludwig¹, A. Coisne², W. Ben Ali³, J. Weimann¹, B. Köll¹, D. Kalbacher⁴, A. Duncan⁵, M. Akodad⁶, A. Scotti⁷, T. K. Rudolph⁸, G. Nickenig⁹, J. Hausleiter¹⁰, H. Ruge¹¹, M. Adam¹², A. S. Petronio¹³, N. Dumonteil¹⁴, L. Sondergaard¹⁵, M. Adamo¹⁶, D. Regazzoli¹⁷, A. Garatti¹⁸, T. Schmidt¹⁹, G. Dahle²⁰, M. Taramasso²¹, T. Walther²², J. Kempfert²³, J.-F. Obadia²⁴, O. Chehab²⁵, G. H. L. Tang²⁶, M. Reardon²⁷, N. Fam²⁸, M. Andreas²⁹, D. W. Muller³⁰, P. Denti³¹, F. Praz³², M. Metra¹⁶, H. Reichenspurner³³, S. Blankenberg¹, A. Latib⁷, R. S. von Bardeleben³⁴, J. F. Granada³⁵, T. Modine³⁶, L. Conradi³³, für die Studiengruppe: CHOICE-MI
¹Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; ²CHU de Lille, Lille, FR; ³Montreal Heart Institute, Montréal, CA; ⁴Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; ⁵Royal Brompton Hospital, London, UK; ⁶St. Paul's Hospital, Vancouver, CA; ⁷Montefiore Medical Center, The Bronx, New York, US; ⁸Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ⁹Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ¹⁰Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; ¹¹Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, München; ¹²Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; ¹³Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italien; ¹⁴Clinique Pasteur, Toulouse, FR; ¹⁵Rigshospitalet, Kopenhagen, DK; ¹⁶Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, IT; ¹⁷Humanitas Research Hospital, Mailand, IT; ¹⁸San Donato Hospital, Mailand, IT; ¹⁹Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ²⁰Rikshopitalet Oslo, Oslo, NO; ²¹Klinik Hirslanden, Zürich, CH; ²²Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main; ²³Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin; ²⁴Louis Pradel Hospital, Lyon, FR; ²⁵St. Thomas' Hospital, London, UK; ²⁶Mount Sinai Hospital, New York, US; ²⁷Houston Methodist Hospital, Houston, US; ²⁸St. Michael's Hospital, Toronto, CA; ²⁹Medizinische Universität Wien, Wien, AT; ³⁰St. Vincent's Hospital, Sydney, AU; ³¹San Raffele Hospital, Mailand, IT; ³²Inselspital Bern, Bern, CH; ³³Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; ³⁴Zentrum für Kardiologie im Herz- und Gefäßzentrum, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; ³⁵Cardiovascular Research Foundation, New York, US; ³⁶CHU de Bordeaux, Bordeaux, FR;
Background: Tricuspid regurgitation (TR) is a common bystander in patients with severe mitral regurgitation (MR). Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with MR and, by effectively eliminating MR, might also have an impact on TR severity. Objectives: This study aimed to assess incidence and prognostic value of TR improvement after TMVR using data from an international multicenter registry. Methods: The CHOICE-MI registry included consecutive patients with symptomatic MR treated with dedicated TMVR devices at 31 international centers. For this study only patients with available echocardiographic data on TR severity were included. TR improvement was defined as a reduction in TR at discharge by at least one grade compared to baseline. Residual MR and NYHA functional class were compared between patients with and without TR improvement. Kaplan-Meier estimates were calculated for the 2-year combined endpoints of all-cause mortality or cardiovascular (CV) mortality and heart failure (HF) hospitalization. Stepwise Cox regression adjusting for age, sex, LVEF, renal function, COPD and atrial fibrillation was applied to assess the prognostic impact of TR improvement. Independent predictors of TR improvement were derived from multivariable analysis. Results: A total of 255 patients undergoing TMVR (age 76.0 years [IQR 71.0-81.0], 58.4% male, EuroSCORE II 6.2% [3.6, 12.1]) were included. TR severity at baseline was mild in 36.5% (N=93), moderate in 43.1% (N=110), severe in 18.0% (N=46), massive in 2.0% (N=5) and torrential in 0.4% (N=1). Following TMVR, 94 patients (36.9%) showed TR improvement by at least one grade, while TR did not improve in 161 patients (63.1%). Patients with TR improvement were younger than patients without TR improvement (75.0 years [IQR 69.9-79.1] vs. 78.0 years [IQR 73.0-82.0], p=0.0043) and worse right ventricular function (TAPSE 15.0mm [IQR 12.0-19.8] vs. 17.0mm [IQR 14.0-20.0], p=0.015), but there were no differences regarding MR severity, MR mechanism, LVEF and LV volumes. At discharge, MR was completely eliminated in the majority of patients regardless of TR improvement (89.4% vs. 86.1%, p=0.57). At 1-year follow-up, the rate of patients at NYHA class I was higher in patients with TR improvement compared to patients without TR improvement (41.4% vs. 24.1%, p=0.048). At 2 years, lower rates were found in patients with TR improvement for the combined endpoints of all-cause mortality of HF hospitalization (36.6% vs. 52.5%, p=0.067), and CV mortality of HF hospitalization (24.8% vs. 44.6%, p=0.039), compared to patients without TR improvement. After multivariate adjustment, TR improvement was independently associated with lower all-cause mortality or HF hospitalization (HR 0.59, 95%-CI 0.36-0.97, p=0.039) and CV mortality or HF hospitalization (HR 0.55, 95%-CI 0.31-0.99, p=0.046). In multivariable analysis, coronary artery disease (HR 0.52, 95%-CI 0.29-0.92, p=0.026) and TAPSE (HR 0.94, 95%-CI 0.88-0.99, p=0.019) were inversely predictive of TR improvement. Conclusions: In this large real-world registry, improvement of TR was found in more than one third of patients with MR undergoing TMVR. TR improvement was an independent predictor of lower mortality and HF hospitalization and was associated with superior symptomatic benefit. These results support the need for echocardiographic follow-up of patients with TR after TMVR.
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