Hemodynamics and prognostic values of exercise stress echocardiography in the perioperative period for patients undergoing transcatheter edge-to-edge repair

Abstract

Listen

Translate article

Abstract Background Exercise stress echocardiography (ESE) is widely used and recommended by guidelines for assessing the severity and prognostic values of mitral regurgitation (MR). However, the changes observed in ESE after MR improvement through transcatheter edge-to-edge repair (TEER) and the relationship between pre- and post-operative ESE evaluations and prognosis remain unclear. Purpose The aim is to investigate the hemodynamic changes observed in ESE before and after TEER using echocardiographic parameters, and to identify factors related to prognosis based on the hemodynamics before and after the procedure. Methods The study included 75 out of 250 cases that underwent TEER from January 2019 to August 2023, which were evaluated with ESE before and after the procedure. Cases with significant valvular disease other than mitral valve disease, those who could not achieve adequate exercise load, and cases with MR due to multiple factors were excluded. Results A significant correlation was observed between postoperative mean pressure gradient (mPG) and pulmonary arterial systolic pressure (PASP) at peak stress (r=0.40, p<0.001), while no significant correlation was found between changes in stroke volume (SV) and changes in PASP (r=0.25, p=0.03). An increase in SV observed on ESE after TEER was associated with a better prognosis compared to cases without such increase, suggesting it as a potential predictor for cardiovascular death (p<0.0001). However, stratification of prognosis based on the presence of peak mPG elevation (mPG ≥ 5 mmHg) or the occurrence of exercise-induced pulmonary hypertension (EIPH) was not achievable. Furthermore, patients who showed an increase in SV in either preoperative or postoperative ESE showed the most favorable prognosis for cardiovascular death (p<0.001). Conclusions Exercise-induced systolic pulmonary artery pressure elevation was found to correlate with the mean pressure gradient postoperatively. Performing exercise stress echocardiography not only for preoperative diagnosis but also postoperatively is useful for prognostic evaluation. Patients with increased stroke volume exhibit a favorable prognosis.