Right ventricular dysfunction assessed by cardiovascular magnetic resonance is associated with poor outcome in patients undergoing transcatheter mitral valve repair.

Maximilian Spieker,Shazia Afzal,Malte Kelm,Ralf Westenfeld,Florian Bönner,Patrick Horn,Daniel Scheiber,Jonathan Marpert,Athanasios Karathanos,Claudio Passino

doi:10.1371/journal.pone.0245637

Abstract

AimsTo evaluate whether CMR-derived RV assessment can facilitate risk stratification among patients undergoing transcatheter mitral valve repair (TMVR).BackgroundIn patients undergoing TMVR, only limited data exist regarding the role of RV function. Previous studies assessed the impact of pre-procedural RV dysfunction stating that RV failure may be associated with increased cardiovascular mortality after the procedure.MethodsSixty-one patients underwent CMR, echocardiography and right heart catheterization prior TMVR. All-cause mortality and heart failure hospitalizations were assessed during 2-year follow-up.ResultsAccording to RV ejection fraction (RVEF) <46%, 23 patients (38%) had pre-existing RV dysfunction. By measures of RV end-diastolic volume index (RVEDVi), 16 patients (26%) revealed RV dilatation. Nine patients (15%) revealed both. RV dysfunction was associated with increased right and left ventricular volumes as well as reduced left ventricular (LV) ejection fraction (all p<0.05). During follow-up, 15 patients (25%) died and additional 14 patients (23%) were admitted to hospital due to heart failure symptoms. RV dysfunction predicted all-cause mortality even after adjustment for LV function. Similarly, RVEDVi was a predictor of all-cause mortality even after adjustment for LVEDVi. Kaplan-Meier survival analysis unraveled that, among patients presenting with CMR indicative of both, RV dysfunction and dilatation, the majority (78%) experienced an adverse event during follow-up (p<0.001).ConclusionIn patients undergoing TMVR, pre-existing RV dysfunction and RV dilatation are associated with reduced survival, in progressive additive fashion. The assessment of RV volumes and function by CMR may aid in risk stratification prior TMVR in these high-risk patients.

Highlights

In patients undergoing transcatheter mitral valve repair (TMVR), only limited data exist regarding the role of Right ventricular (RV) function
In patients undergoing TMVR, only limited data exist regarding the role of RV function
Kaplan-Meier survival analysis unraveled that, among patients presenting with cardiovascular magnetic resonance (CMR) indicative of both, RV dysfunction and dilatation, the majority (78%) experienced an adverse event during follow-up (p

Summary

Methods

Sixty-one patients underwent CMR, echocardiography and right heart catheterization prior TMVR. All-cause mortality and heart failure hospitalizations were assessed during 2-year follow-up. Sixty-one patients undergoing MitraClip (Abbott Vascular, Santa Clara, California) implantation at the university hospital Duesseldorf, Germany were included between 2014–2019 and underwent CMR, echocardiography and RHC prior to TMVR. We stratified patients according to the presence/absence of RV systolic dysfunction according to the RV ejection fraction (RVEF). Patients were separated into groups according to the presence/absence of RV dilatation. For assessment of RV dilatation, the RV end-diastolic volume index (RVEDVi) assessed by CMR was matched to age and gender specific reference values for each patient.(9) In this regard, in men 111 ml/m2, and in men 60 years RVEDVi >101 ml/m2 was defined as RV dilatation. In women 96 ml/m2, and in women 60 years RVEDVi >84 ml/m2 was defined as RV dilatation [9]

Results

Discussion

Conclusion