Abstract
Abstract 16372: Prognostic Value of Baseline Right Ventricular Dysfunction Using TAPSE and TAPSE to PASP Ratio in Patients Undergoing Mitra-Clip: Systematic Review and Meta-Analysis
Circulation (New York, N.Y.), Vol.148(Suppl_1), pp.A16372-A16372
11/07/2023
DOI: 10.1161/circ.148.suppl_1.16372
Abstract
Abstract only
Introduction:
Transcatheter edge-to-edge mitral valve repair (TEER) using Mitra-clip is an established therapy for high-risk surgical candidates who are refractory to optimal medical treatment. Several reports have shown that right ventricular dysfunction (RVD) is associated with increased morbidity and mortality in heart failure (HF) patients. Emerging data on the relationship between baseline RVD and post-TEER mortality has been published.
Objective:
Our main goal is to assess the prognostic impact of baseline RV function markers; tricuspid annular plane excursion (TAPSE) and TAPSE/PASP (pulmonary arterial systolic pressure) ratio, as an expression of the right ventricle-pulmonary artery coupling following Mitra-Clip.
Methods:
MEDLINE and EMBASE were searched for studies discussing outcomes of Mitra-Clip in patients with and without RV dysfunction as expressed by TAPSE or TAPSE:PASP ratio. Two reviewers independently screened the studies and extracted the pertinent survival data. Odds ratios (OR) with 95% confidence interval were calculated using a random-effects model.
Results:
Twelve reports enrolling 3515 patients (1443 with and 2072 without pre-existing RVD) were included. Patients with RVD had OS reduction after Mitra-Clip by 55% at 6 months, 60% at one year, and 63% at two years [OR: 0.45 (0.35-0.58), 0.40 (0.33-0.48), 0.37 (0.31-0.45) respectively;
P
< .001] compared to normal RV group. Likewise, HR readmission free survival was minimized among RVD patients by 53% at 6 months, 56% at one year, and 59% at two years compared to normal RV group [OR: 0.47 (0.35-0.65), 0.44 (0.35-0.55), 0.41 (0.30-0.56) respectively;
P
< .00001]. TAPSE:PASP ≤ 0.30-0.37 was associated with lower OS and HF re-admission free survival at 6 months (OR: 0.37, 0.44;
P
< .00001) and 1 year (OR: 0.35, 0.41;
P
< .00001) after Mitra-Clip. Furthermore, TAPSE ≤ 15-16 negatively impacted the OS at 6 months (OR: 0.40
P
< .00001) and 1 year (OR: 0.50;
P
< .00001) after Mitra-Clip.
Conclusions:
Pre-existing RV dysfunction as expressed by TAPSE ≤15-16 or TAPSE:PASP ratio ≤ 0.30-0.37 decreased the overall survival and HF readmission free survival after Mitra-Clip therapy. Further research is warranted to guide interventional timing based on the degree of RV dysfunction.
Details
- Title: Subtitle
- Abstract 16372: Prognostic Value of Baseline Right Ventricular Dysfunction Using TAPSE and TAPSE to PASP Ratio in Patients Undergoing Mitra-Clip: Systematic Review and Meta-Analysis
- Creators
- Anan Abu Rmilah - Regional HealthRamy Ghaly - Kansas City, MOCarlos Pfeiffer - Regional HealthVictor Camba - Regional HealthMOHAMED HAG SAEED - Internal medicine, Cardiology, Saudi ArabiaAbdulrahman Khojah - Internal medicine, Cardiology, Saudi ArabiaAnjula Chib - Regional HealthAziz Tabash - Regional HealthJohn Raper - Regional HealthSuhaib Jaber - Internal medicine, Cardiology, Saudi ArabiaPaul Volansky - Regional Healthmandar jagtap - Regional Health
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.148(Suppl_1), pp.A16372-A16372
- DOI
- 10.1161/circ.148.suppl_1.16372
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Language
- English
- Date published
- 11/07/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984845669102771
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