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Publications

Journal Article Ahead of print

PubMed: 42723620 DOI: 10.1161/CIRCINTERVENTIONS.126.016634

Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry.

Circ Cardiovasc Interv

Authors: Andrea Scotti, Sebastian Ludwig, Daniel Feldman, Benedikt Koell, Jessica Weimann, Philipp von Stein, Alejandro Araujo Adams, Adrian Heinze, Dhairya Patel, Lukas Stolz, Robin Le Ruz, Tetsu Tanaka, Teresa Trenkwalder, Felix Rudolph, Daryoush Samim, Cristina Giannini, Julien Dreyfus, Jean-Michel Paradis, Marianna Adamo, Nicole Karam, Yohann Bohbot, Anne Bernard, Bruno Melica, Yusuke Kobari, Yoan Lavie-Badie, Mirjam Kessler, Omar Chehab, Simon Redwood, Edith Lubos, Ole de Backer, Marco Metra, Marcel Weber, Tanja Rudolph, Chiara Primerano, Marco De Carlo, Christos Iliadis, Fabien Praz, Muhammed Gerçek, Erion Xhepa, Georg Nickenig, Raj Makkar, Jörg Hausleiter, Erwan Donal, Rodrigo Estévez-Loureiro, Ignacio Cruz-González, Juan Granada, Thomas Modine, Augustin Coisne, Daniel Kalbacher, Azeem Latib

Affiliations

  • Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S. D.F. A.A.A. A.L.).
  • Interventional Cardiology, White Plains Hospital, NY (A.S. A.L.).
  • Department of Cardiology, Hospital Universitario de Salamanca, CIBERCV, IBSAL, Spain (A.S. I.C.-G.).
  • Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Germany (S.L. B.K. J.W. A.H. D.K.).
  • DZHK, German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Germany (S.L.).
  • Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany (P.v.S.).
  • Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.P. C.I. R.M.).
  • Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Germany (L.S. J.H.).
  • Nantes Université, CHU Nantes, Interventional Cardiology Department, L'institut du thorax, France (R.L.R.).
  • Department of Internal Medicine II, Heart Center Bonn, Germany (T. Tanaka, M.W. G.N.).
  • Department of Cardiology, German Heart Center Munich, Technical University of Munich, Germany (T. Trenkwalder, E.X.).
  • Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.R. T.R. M.G.).
  • Universitätsklinik für Kardiologie, Inselspital Bern, Switzerland (D.S. F.P.).
  • S.D. Emodinamica, AOUP-Azienda Ospedaliero Universitaria Pisana, Italy (C.G. C.P. M.D.C.).
  • Cardiology Department, Centre Cardiologique du Nord, Paris, France (J.D.).
  • Quebec Heart & Lung Institute, Laval University, Quebec, Canada (J.-M.P.).
  • University of Brescia, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Brescia, Italy (M.A. M.M.).
  • Cardiology Department, European Hospital Georges Pompidou, Paris, France (N.K.).
  • Department of Cardiology, Amiens University Hospital, France (Y.B.).
  • Cardiology Department, CHRU de Tours, France (A.B.).
  • Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal (B.M.).
  • Rigshospitalet, Copenhagen University Hospital Copenhagen, Denmark (Y.K. O.d.B.).
  • Department of Cardiology, Rangueil University Hospital, Toulouse, France (Y.L.-B.).
  • Department of Internal Medicine II, Ulm University Heart Center, Germany (M.K.).
  • Department of Cardiology, St. Thomas' Hospital, London, United Kingdom (O.C. S.R.).
  • Marienkrankenhaus, Hamburg, Germany (E.L.).
  • Rennes University Hospital, INSERM, LTSI-UMR 1099, University of Rennes, France (E.D.).
  • Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain (R.E.-L.).
  • Cardiovascular Research Foundation, New York City, NY (J.G.).
  • Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Centre Hospitalier Universitaire Bordeaux, France (T.M.).
  • Department of Clinical Physiology and Echocardiography - Heart Valve Clinic, CHU Lille, France (A.C.).

Abstract

BACKGROUND

The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation. This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with primary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER).

METHODS

The PRIME-MR registry (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation) included 3083 patients with severe primary mitral regurgitation undergoing M-TEER from 2008 to 2022 at 25 international sites. Only patients with successful M-TEER procedures (mitral regurgitation≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) versus TR≥Severe (TR≥Sev). The primary end point was 2-year all-cause mortality.

RESULTS

A total of 2155 patients were analyzed: TR≥Sev (n=421 [20%]) versus TR≤Mod (n=1734 [80%]). Patients with TR≥Sev were more likely to be New York Heart Association III/IV (P=0.003), have shorter 6-minute walk distance (P<0.001), higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; P<0.001), higher creatinine (P<0.001), higher pulmonary artery pressures (P<0.001), atrial fibrillation (P<0.001), and more diuretics (P<0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% versus 19.6%; P log-rank<0.0001) and heart failure hospitalization (21.1% versus 16.8%; P Gray=0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (adjusted hazard ratio, 2.01 [95% CI, 1.35-3.00]; P<0.001). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% versus 19.9%; P log-rank=0.0037) than TR≤Mod.

CONCLUSIONS

In the PRIME-MR registry, 20% of patients with primary mitral regurgitation had severe TR at baseline. TR severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2 years.

MeSH

Registries, Mortality, Cardiovascular Surgical Procedures, Heart Failure, Tricuspid Valve Insufficiency, Mitral Valve Insufficiency