ISSN 2996-8215
International Journal of Cardiology | Vol. 13, No. 4, April 2022 | pp. 25–32
DOI: 10.46882/2022/IJC/000157
Original Research Article
Prognostic Value of Right Ventricular Longitudinal Strain in Patients Undergoing Percutaneous Transcatheter Mitral Valve Edge-to-Edge 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 edge-to-edge repair (TEER) using the MitraClip system is a validated intervention for high-surgical-risk patients presenting with severe mitral regurgitation (MR). While conventional selection parameters prioritize left ventricular dimensions, right ventricular (RV) baseline status may significantly influence clinical trajectory. This study evaluated the prognostic value of right ventricular free-wall longitudinal strain (RV-FWS) derived from speckle-tracking echocardiography for predicting 2-year survival post-TEER. We prospectively followed 150 consecutive high-risk patients with severe functional or organic MR who underwent successful TEER. Baseline absolute RV-FWS was quantified off-line from apical focus views. The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 24 months. Impaired baseline RV mechanics, defined as an absolute RV-FWS less than 16.0%, was present in 36.0% of the cohort. At 2 years, the primary endpoint was significantly higher in patients with impaired baseline strain compared to those with preserved RV strain (46.3% vs. 20.8%, log-rank p = 0.002), driven primarily by recurrent heart failure rehospitalizations (37.0% vs. 13.5%, p < 0.01). Multivariable Cox proportional hazards analysis confirmed that an absolute baseline RV-FWS less than 16.0% was a powerful independent predictor of the 2-year composite endpoint (hazard ratio: 2.14, 95% CI: 1.25–3.62, p = 0.005), whereas traditional tricuspid annular plane systolic excursion (TAPSE) metrics lost significance. Baseline right ventricular free-wall longitudinal strain is an independent predictor of long-term failure transitions following transcatheter mitral valve repair.
Keywords: Mitral regurgitation, Transcatheter edge-to-edge repair, MitraClip, Right ventricular strain, Speckle-tracking echocardiography, Prognosis
Received: January 08, 2022; Revised: February 22, 2022; Accepted: March 15, 2022; Published: April 24, 2022
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