Pulmonary Hypertension in Patients Eligible for Transcatheter Mitral Valve Repair: Prognostic Impact and Clinical Implications

The impact of pulmonary hypertension on prognosis in moderate-to-severe mitral regurgitation patients treated with transcatheter edge-to-edge mitral valve repair: a comprehensive meta-analysis

Objective

This meta-analysis aims to assess the impact of pulmonary hypertension (PH) on the clinical prognosis of patients with moderate to severe mitral valve regurgitation (MR) undergoing transcatheter edge-to-edge mitral valve repair (TEER).

Methods

As of August 2024, relevant studies were identified through searches of the PubMed, Cochrane Library, Web of Science, and Embase databases. A comprehensive screening process was conducted, with quality assessment performed utilizing the Newcastle Ottawa Scale (NOS). Data analysis was carried out using Stata17.0 software, generating forest plots, funnel plots, Egger's test, and sensitivity analysis plots to analyze heterogeneity and publication bias. Odds ratios (OR) and standardized mean differences (SMD) were calculated for dichotomous and continuous variables, respectively, each presented with a 95% confidence interval (CI).

Results

A total of 10 studies involving 28,404 patients were included, with all articles achieving a NOS score of ≥7. The outcome indicators were as follows: 2-year all-cause mortality [OR = 2.06, 95%CI(1.49, 2.84), p < 0.01, I 2 = 79.9%]; heart failure rehospitalization rate [OR = 1.56, 95%CI(1.29,1.76), p < 0.01, I 2 = 41.7%]; 30-day all-cause mortality [OR = 2.10, 95%CI(1.78,2.47), p < 0.01, I 2 = 0%]; cardiogenic mortality [OR = 2.00, 95%CI (1.61,2.49), p < 0.01, I 2 = 0%]; and length of hospital stay [OR = 0.17, 95%CI(0.14,0.20), p < 0.01, I 2 = 0%]. All outcome indicators demonstrated that the PH group had significantly worse outcomes compared to the non-PH group. Subgroup analyses were performed on outcome indicators with notable heterogeneity, focusing on PH measurement methods, PH diagnostic criteria, and the severity of PH. The results indicated that most combined subgroup outcomes were consistent with the overall findings and showed significantly reduced heterogeneity. The sources of heterogeneity are likely attributed to the methods of PH measurement, diagnostic criteria for PH, and the severity of PH.

Conclusion

Within two years after undergoing transcatheter edge-to-edge repair (TEER), patients with MR and PH experiecne significantly higher rates of all-cause mortality, 30-day all-cause mortality, heart failure readmissions, cardiogenic mortality, and longer hospital stays compared to those without PH.

Systematic Review Registration

https://inplasy.com/, identifier (INPLASY202480068).

Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair

BACKGROUND

In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr).

METHODS

Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional-hazard regression was created utilizing MR type, STS-score, and RLR to assess the independent association of RLR with survival. Kaplan-Meier analysis was used to analyze the association between RAVI and LAVI with all-cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups.

RESULTS

Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow-up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all-cause mortality while patients with high LAVI and low RAVI had significantly improved all-cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion-hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all-cause mortality [HR = 2.304; 95% CI = 1.26-4.21, p = 0.006] when MR type and STS score were accounted for.

CONCLUSION

Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS-score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr.