RV Myocardial Work Reserve as Clinical Improvement Predictor in HFrEF Patients after TEER-A Pilot Study

Abstract

Backgrounds: It remains uncertain which kind of heart failure with reduced ejection fraction (HFrEF) patients would benefit the most from transcatheter edge-to-edge repair (TEER). Objectives We aim to investigate the relationship between right ventricular function, as assessed by pressure-strain loops (PSL), and post-TEER clinical improvement. Methods A total of 48 HFrEF patients (68 ± 15 yrs) with moderate-to-severe or severe SMR were enrolled for TEER. Impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-min walk distance [6MWD]) were evaluated at baseline and during 1-year follow up. Before and right after TEER, myocardial work (MW) metrics were non-invasively evaluated, including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Results RV GLS, RVGWI, RVGCW, RVGWE were significantly increased after MitraClip treatment (-9.7 ± 3.8%, 452.4 ± 112.5 mmHg%, 596.3 ± 127.5 mmHg% and 85.7 ± 15.6% before vs -12.5 ± 3.5%, 589.4 ± 119.6 mmHg%, 778.8 ± 135.3 mmHg% and 91.2 ± 22.4% after MitraClip treatment, p = 0.025, 0.030, 0.025 and 0.037, respectively). The Kaplan-Meier estimates for survival, freedom from HF hospitalization at 12 months were 95.8% and 89.1%. On multivariable linear regression analysis, RVGWI and RVGCW immediate change was independently associated with KCCQ-OS (△RVGWI: 𝛃 = 0.40, P < 0.001; △RVGCW: 𝛃 = 0.39, P = 0.003), RVGWI, RVGCW and RVGLS immediate change were independently associated with 6MWD improvement (△RVGWI: 𝛃 = 0.31, P = 0.029; △RVGCW: 𝛃 = 0.30, P = 0.039; △RVGLS: 𝛃 = 0.35, P = 0.041). Conclusion RVMW was significantly increased after MitraClip treatment. And RV reserve function is an important predictor of clinical improvement in HFrEF patients with TEER.