Prognostic relevance of mitral and tricuspid regurgitation after transcatheter aortic valve implantation: Impact of follow-up time point for decision-making

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Mahmoud Diab¹  Karim Ibrahim²  Sven Möbius-Winkler³  Marcus Franz³  P. Christian Schulze³  Julian G. Westphal³  Laura Bäz⁴  Thomas Kräplin⁵ 

[1] Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany;Department of Internal Medicine I, Klinikum Chemnitz, Chemnitz, Germany;Department of Internal Medicine I, University Hospital Jena, Jena, Germany;Department of Internal Medicine I, University Hospital Jena, Jena, Germany;Research Program “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Jena, Germany;University Hospital Jena, Jena, Germany;

关键词: transcatheter aortic valve implantation;    mitral regugitation;    tricuspid regurgitation;    prognosis;    treatment;   

DOI  :  10.3389/fcvm.2023.990373

 received in 2022-07-09, accepted in 2023-01-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundIn patients with aortic stenosis treated by transcatheter aortic valve implantation (TAVI), mitral and tricuspid regurgitation (MR and TR) at baseline and after TAVI are likely to be of prognostic relevance, and questions such as whether and when treatment further improves prognosis in these patients arise.AimsAgainst that background, the purpose of this study was to analyze a variety of clinical characteristics including MR and TR with respect to their potential value as predictors of 2-year mortality after TAVI.MethodsA cohort of 445 typical TAVI patients was available for the study and clinical characteristics were evaluated baseline, 6 to 8 weeks as well as 6 months after TAVI.ResultsIn 39% of the patients relevant (moderate or severe) MR and in 32% of the patients relevant (moderate or severe) TR could be detected at baseline. The rates were 27% for MR (p = 0.001, compared to baseline) and 35% for TR (p = n.s., compared to baseline) at the 6- to 8-week follow-up. After 6 months, relevant MR was observable in 28% (p = 0.036, compared to baseline) and relevant TR in 34% (p = n.s., compared to baseline) of the patients. As predictors of 2-year mortality, a multivariate analysis identified the following parameters for the different time points: sex, age, AS entity, atrial fibrillation, renal function, relevant TR, systolic pulmonary artery pressure (PAPsys), and 6-min walk distance at baseline; clinical frailty scale and PAPsys 6–8 weeks after TAVI and BNP and relevant MR 6 months after TAVI. There was a significantly worse 2-year survival in patients with relevant TR at baseline (68.4% vs. 82.6%, p < 0.001; whole population, n = 445) and in patients with relevant MR at 6 months (87.9% vs. 95.2%, p = 0.042; landmark analysis: n = 235).ConclusionThis real-life study demonstrated the prognostic relevance of repeated evaluation of MR and TR before and after TAVI. Choosing the right time point for treatment is a remaining clinical challenge, which should be further addressed in randomized trials.

【 授权许可】

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Copyright © 2023 Bäz, Möbius-Winkler, Diab, Kräplin, Westphal, Ibrahim, Schulze and Franz.