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

Laura Bäz; Sven Möbius-Winkler; Mahmoud Diab; Thomas Kräplin; Julian G Westphal; Karim Ibrahim; P Christian Schulze; Marcus Franz

doi:10.3389/fcvm.2023.990373

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

Front Cardiovasc Med. 2023 Feb 16:10:990373. doi: 10.3389/fcvm.2023.990373. eCollection 2023.

Authors

Laura Bäz^{1

2}, Sven Möbius-Winkler¹, Mahmoud Diab³, Thomas Kräplin⁴, Julian G Westphal¹, Karim Ibrahim⁵, P Christian Schulze¹, Marcus Franz¹

Affiliations

¹ Department of Internal Medicine I, University Hospital Jena, Jena, Germany.
² Research Program "Else Kröner-Forschungskolleg AntiAge", Jena University Hospital, Jena, Germany.
³ Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany.
⁴ University Hospital Jena, Jena, Germany.
⁵ Department of Internal Medicine I, Klinikum Chemnitz, Chemnitz, Germany.

Abstract

Background: In 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.

Aims: Against 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.

Methods: A 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.

Results: In 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).

Conclusion: This 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.

Keywords: mitral regugitation; prognosis; transcatheter aortic valve implantation; treatment; tricuspid regurgitation.