Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation

Abstract

BackgroundRight ventricular dysfunction (RVdysf) is a predictor of poor outcome in patients with heart failure and valvular disease. The aim of this study was to evaluate the evolution and the impact of RVdysf in patients with moderate–severe functional mitral regurgitation (FMR) successfully treated with MitraClip.Methods and resultsFrom October 2008 to July 2014, 60 consecutive high surgical risk FMR patients were evaluated and stratified into two groups: RVdysf group (TAPSE < 16 mm and/or S′TDI < 10 cm/s, 21 patients) and No-RVdysf group (38 patients). The overall mean age of patients was 73 ± 8 (83% male). Ischemic FMR etiology was present in 67%. Mean LVEF was 30 ± 10%. Overall mean time follow-up was 565 ± 310 days. The only significant difference between the two groups was a greater prevalence of stroke, ICD and use of aldosterone antagonist in RVdysf group. Acute procedural success was achieved in 90% of patients. At 6-month echo-matched analysis significant RV function improvement was observed in patients with baseline RVdysf (TAPSE 15 ± 3.0 vs. 19 ± 4.5, p = 0.007; S′TDI 7 ± 1.2 vs. 11 ± 2.8, p < 0.0001; baseline vs. 6-month, respectively). The mean improvement in the 6-min walking test was significant in both groups (120 and 143 m, RVdysf and No-RVdysf groups, respectively). At Kaplan–Meier analysis, the presence of RVdysf did not affect the outcome in terms of freedom from composite efficacy endpoint.ConclusionsThis study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.

Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR)

“…This observation is in line with our findings, and moreover, we found an improved RV-EF immediately after the PMVR procedure in patients with reduced RV-EF at baseline. It has been shown previously that echocardiography-derived 2D parameters like TAPSE and tissue Doppler derived peak systolic velocity of the lateral tricuspid annulus can identify patients with an increased risk of cardiovascular mortality despite a successful PMVR procedure [[25], [26], [27], [28]]. In our rather small patient collective, 12.5% of the patients with reduced RV-EF below 35% have died, whereas in the group of patients with RV-EF above 35%, 23.81% had died within 6 months after the PMVR procedure.…”

The Right Heart-Pulmonary Circulation Unit and Left Heart Valve Disease

“….042). Conversely, Godino P 5 and colleagues 58 reported that successful Mitra-Clip procedure leads to a significant improvement of RV function even in patients with baseline RV dysfunction (TAPSE <16 mm and/or S' <10 cm/s). Reverse RV remodeling and reduced RV pressure overload by regression of MR and sPAP might explain its functional benefit.…”

“…In a small study including 60 patients with high-risk functional MR undergoing MitraClip, moderate and severe RV dysfunction (TAPSE <16 mm and S' <10 cm/s) was noticed in 37% of cases. 58 RV dysfunction results from complex hemodynamic and structural changes. Downstream, chronic MR leads to LV volume overload with subsequent LV enlargement and a decrease of interventricular septal function, and upstream, induces an increase in LA pressure and with a subsequent increase in sPAP and PCWP.…”

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

“…Importantly, TMVr treatment is capable of improving RV function. One study found an improvement of tricuspid annular plane excursion by 4 mm and peak systolic velocity by 4 cm/s at 6 months follow up [73] .…”