Right Ventricular Cardiac Power Index Predicts 1 Year Outcome After Transcatheter Edge-to-Edge-Repair for Severe Tricuspid Valve Regurgitation.

Tricuspid transcatheter edge-to-edge repair (T-TEER) for severe tricuspid regurgitation (TR) emerged as a novel treatment option for patients not amenable to surgery. However, knowledge regarding independent risk factors for a worse prognosis is rarely available. The study sought to investigate the impact of right ventricular cardiac power index (RVCPi) on 1-year outcomes in patients with severe symptomatic TR who underwent T-TEER. Consecutive patients with severe TR who underwent T-TEER from August 2020 to March 2022 were included and followed prospectively. Baseline clinical and invasive hemodynamic variables, changes in echocardiographic parameters and New York Heart Association functional class, and periprocedural and in-hospital major adverse events were assessed. Primary end point was defined as a composite of all-cause mortality and heart failure hospitalization at 1 year after T-TEER. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for combined primary end point. RVCPi was calculated as: (cardiac index × mean pulmonary pressure) × K (conversion factor 2.22 × 10-3) = W/m². Receiver operator characteristic analysis was used to determine discriminative capacity of RVCPi. The prognostic value of RVCPi threshold was tested using Kaplan-Meier analysis. In total, 102 patients (mean age 81 ± 6 years, 51% women) at high operative risk underwent T-TEER for severe TR. Primary end point occurred in 30 patients (32%). Receiver operator characteristic curve analysis demonstrated that RVCPi was associated with an area under the curve of 0.69 (95% confidence interval 0.56 to 0.82; p = 0.003). With a RVCPi threshold of 0.17 W/m² (maximally selected rank statistics), the event-free survival was significantly higher in the RVCPi <0.17 W/m² group compared with those with RVCPi ≥0.17 W/m² (71% vs 35%, log-rank p <0.001). In the multivariable Cox regression analysis, RVCPi was an independent predictor for the combined primary end point (hazard ratio 2.6, 95% confidence interval 1.4 to 5.1, p = 0.003). In conclusion, RVCPi is associated with outcome in patients who underwent T-TEER for severe TR and this hemodynamic predictor is useful in risk stratification of T-TEER candidates.

Influence of the ratio of mean arterial pressure to right atrial pressure on outcome after successful percutaneous edge-to-edge repair for severe mitral valve regurgitation.

BACKGROUND: It is important to identify further predictors of outcome after successful transcatheter mitral valve repair (TMVR), as optimal patient selection remains difficult. OBJECTIVE: The study investigates the prognostic benefit of the mean arterial pressure (MAP) to right atrial pressure (RAP) ratio (MAP/RAP ratio) after successful TMVR in patients with congestive heart failure (CHF) and severe mitral regurgitation (MR). METHOD: Patients with CHF and severe MR were enrolled after successful TMVR (MR ≤ 2+ at discharge). The primary endpoint was a composite of all-cause mortality or hospitalisation for heart failure. The median follow-up time was 16 ± 9 months. Receiver Operating Characteristic (ROC) analysis was applied to assess the discriminatory power of the MAP/RAP ratio. The predictive value of the MAP/RAP ratio threshold was investigated using a Kaplan-Meier analysis. Multivariable logistic regression analysis was conducted to evaluate independent risk factors for the combined primary endpoint. RESULTS: 145 patients (median age 76 [69-80 years], 60.3% male) were included. ROC curve analysis showed that MAP/RAP ratio was associated with an area under the curve of 0.62 (95% confidence interval (CI) 0.53-0.71; p = 0.01). A MAP/RAP ratio threshold of 7.13 was associated with 67.4% sensitivity and 57.0% specificity for the combined primary endpoint. Event-free survival was significantly lower in the MAP/RAP ratio < 7.13 group compared to those with MAP/RAP ratio ≥ 7.13 (62.2% versus 39.4%; log-rank p = 0.022). In logistic regression analysis MAP/RAP ratio was an independent predictor for the combined primary endpoint (odds ratio 0.75; 95% CI 0.62-0.90; p = 0.002). CONCLUSIONS: The MAP/RAP ratio is associated with an unfavorable outcome in patients undergoing successful TMVR. Therefore, this new index could improve prognostic assessment of TMVR candidates.

Impact of Ventricular Stroke Work Indices on Mortality in Heart Failure Patients After Percutaneous Mitral Valve Repair.

Optimal patient selection for transcatheter mitral valve repair (TMVR) remains challenging. The aim of the study was to assess the impact of left and right ventricular stroke work index (LVSWi, RVSWi) on mortality in patients with chronic heart failure (CHF) undergoing TMVR. One hundred-forty patients (median age 74 ± 9.9 years, 67.9% male) with CHF who underwent successful TMVR were included. Primary end point was defined as all-cause mortality after 16 ± 9 months of follow-up. LVSWi was calculated as: Stroke volume index (SVi) * (mean arterial pressure - postcapillary wedge pressure) * 0.0136 = g/m-1/m2. RVSWi was calculated as: SVi * (mean pulmonary artery pressure - right atrial pressure) * 0.0136 = g/m-1/m2. Receiver operating characteristic (ROC) analysis determined an optimal threshold of 24.8 g/m-1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60 to 0.81]; p = 0.001) and 8.3 g/m-1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56 to 0.78]; p = 0.006), respectively. Kaplan-Meier analysis showed significantly lower survival in patients with LVSWi ≤24.8 g/m-1/m2 (20.0% vs 39.4%; log-rank p = 0.038) and in patients with RVSWi ≤8.3 g/m-1/m2 (22.1% vs 43.7%; log-rank p = 0.026), respectively. LVSWi of ≤24.8 g/m-1/m2 and RVSWi of ≤8.3 g/m-1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p = 0.04; HR 2.52; 95% CI 1.04 to 6.1; p = 0.041). A risk-score incorporating LVSWi and RVSWi cut-off values from ROC analysis powerfully predicts long-term survival after successful TMVR (log-rank p = 0.02). In conclusion, LVSWi and RVSWi independently predict mortality in patients with CHF undergoing TMVR and might be useful in risk stratification of TMVR candidates.