ISSN 2996-8215
International Journal of Cardiology | Vol. 2, No. 2, February 2011 | pp. 9–16
DOI: 10.46882/2011/IJC/000023
Original Research Article
Prognostic Impact of Right Ventricular Dysfunction in Patients Undergoing Transcatheter Mitral Valve Repair
Matteo Barbieri¹, Francesca Costa¹, Luigi Marini²
¹Department of Cardiology, San Raffaele Hospital, Milan, Italy
²Division of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
Abstract:
Transcatheter mitral valve repair using the MitraClip system is a validated therapy for high-risk surgical patients with severe mitral regurgitation (MR). While left ventricular parameters are traditionally prioritized, the impact of baseline right ventricular (RV) dysfunction on post-procedural outcomes is less defined. This study investigated whether pre-procedural RV dysfunction predicts long-term mortality and heart failure hospitalization after transcatheter repair. We prospectively evaluated 140 consecutive patients with severe functional or degenerative MR who underwent successful MitraClip implantation. Baseline RV function was categorized as normal or impaired based on tricuspid annular plane systolic excursion (TAPSE less than 16 mm) and RV fractional area change (FAC less than 35%). The primary endpoint was a composite of all-cause mortality and heart failure hospitalization at 2 years. Baseline RV dysfunction was present in 52 patients (37.1%). At 2 years, the primary endpoint was significantly higher in patients with baseline RV dysfunction compared to those with normal RV function (44.2% vs. 21.6%, log-rank p = 0.005). This difference was driven by both higher mortality (23.1% vs. 10.2%, p = 0.03) and recurrent heart failure hospitalizations (34.6% vs. 14.8%, p = 0.01). Multivariable Cox regression identified a baseline TAPSE less than 16 mm as an independent predictor of the composite outcome (hazard ratio: 2.15, 95% CI: 1.28–3.62, p = 0.004). Pre-procedural right ventricular dysfunction is a powerful, independent predictor of poor 2-year clinical outcomes in high-risk patients undergoing transcatheter mitral valve repair, highlighting the need for comprehensive biventricular assessment.
Keywords: Mitral regurgitation, MitraClip, Right ventricular dysfunction, TAPSE, Heart failure, Prognosis
Received: November 05, 2010; Revised: December 18, 2010; Accepted: January 10, 2011; Published: February 20, 2011
Citation: International Journal of Cardiology, 2011, Vol. 2, No. 2, pp. 9–16, DOI: 10.46882/2011/IJC/000023