Evaluation of three-dimensional right ventricular function and reverse remodelling in patients undergoing percutaneous mitral valve repair for functional mitral regurgitation: insights from a multicentre Italian registry - 2025
Evaluation of three-dimensional right ventricular function and reverse remodelling in patients undergoing percutaneous mitral valve repair for functional mitral regurgitation: insights from a multicentre Italian registry
_Evaluation of three-dimensional right ventricular function and reverse remodelling in patients undergoing percutaneous mitral valve repair for functio.pdf
Functional mitral regurgitation; mitral TEER; right ventricle dysfunction, 3D-echocardiography threedimensional; FMR: functional mitral regurgitation; MRVD: mild-to-moderate rightventricular dysfunction; No-RVD: No right ventricular dysfunction; RV: right ventricular; RVD: right ventricular dysfunction; RVEDVi: right ventricular end-diastolic volume index; RVEF: right ventricular ejection fraction; RVESVi: right ventricular end-systolic volume index; SRVD: severe right ventricular dysfunction; TEER: transcatheter edgeto-edge repair FAC: Fractional area change; FMR: Functional mitral regurgitation; FWL: Free wall longitudinal strain; HF: Heart failure; LV: Left ventricular; LVEF: Left ventricular ejection fraction; MRVD: Mild-to-moderate right ventricular dysfunction; NT-proBNP: N-terminal pro-B-type natriuretic peptide; NYHA: New York Heart Association; RV: Right ventricular; RVD: Right ventricular dysfunction; RVEF: Right ventricular ejection fraction; PASP: Pulmonary artery systolic pressure; RVRR: Right ventricular reverse remodelling; SRVD: Severe right ventricular dysfunction; s' TDI: Systolic wave velocity at tissue Doppler imaging; TAPSE: Tricuspid annular plane systolic excursion; TEER: Transcatheter edge-to-edge repair; 2D: Two-dimensional; 3D: Three-dimensional
Abstract :
[en] Background: The predictive role of right ventricular dysfunction (RVD) in patients with functional mitral regurgitation (FMR) undergoing transcatheter edge-to-edge repair (TEER), as well as RV remodelling following the procedure, remains uncertain. We evaluated the prognostic impact of pre-procedural three-dimensional (3D) right ventricular ejection fraction (RVEF) in patients with FMR. Additionally, we assessed the RV reverse remodelling (RVRR) based on 3D volumes and ejection fraction six months after the procedure. Methods: Data from 74 patients treated with TEER for FMR were prospectively collected. Pre-procedural RVD, defined as 3D RVEF ≤45%, was observed in 47 patients (63.5%). Patients were divided into three groups according to pre-procedural 3D-RVEF: no RVD (No-RVD, RVEF >45%, n = 27), mild-to-moderate RVD (MRVD, RVEF 31-45%, n = 36), and severe RVD (SRVD, RVEF ≤30%, n = 11). Results: Patients with SRVD demonstrated a significant higher rate of all-cause mortality compared with the other two groups (p = 0.04) and RVEF ≤ 30% was associated with all-cause death, independently of left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi) (HR: 3.72, 95% CI 1.12-12.30, p = 0.03). At 6-month follow-up, only patients with pre-procedural MRVD showed a significant reduction in 3D RV volumes and an improvement in RVEF compared to baseline (p < 0.05). Conclusions: RVD was common among patients undergoing mitral TEER for FMR. Those with pre-procedural SRVD had worse mid-term survival compared to patients with MRVD and No-RVD. The group with MRVD was the only one to demonstrate an RVRR six months after the procedure.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Viva, Tommaso ; department of clinical and interventional cardiology, Milan, italy
Zannoni, Jessica ; department of clinical and interventional cardiology, Milan, italy
Rubbio, Antonio; department of clinical and interventional cardiology, Milan, italy
Lupi, Laura; cardiac catheterization laboratory and cardiology, ASSt Spedali civili and department of Medical and Surgical Specialties, radiological Sciences and Public Health, University of Brescia, Brescia, italy
Agricola, Eustachio; cardiovascular imaging Unit, irccS San raffaele Hospital, Vita-Salute San raffaele University, Milan, italy ; d cardiology Unit, cardio-thoracic-Vascular department, University of Bologna, Bologna, italy
Biagini, Elena; Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant’Orsola-Malpighi Hospital, University of Bologna
Adamo, Marianna; cardiac catheterization laboratory and cardiology, ASSt Spedali civili and department of Medical and Surgical Specialties, radiological Sciences and Public Health, University of Brescia, Brescia, italy
Giannini, Cristina; cardiac catheterization laboratory, University of Pisa and Azienda ospedaliero-Universitaria Pisana, Pisa, italy
Berardini, Alessandra; Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant’Orsola-Malpighi Hospital, University of Bologna
Scandura, Salvatore; division of cardiology, A.o.U. Policlinico "g. rodolico San Marco", italy
Grasso, Carmelo; division of cardiology, A.o.U. Policlinico "g. rodolico San Marco", italy
Boveri, Sara; laboratory of Biostatistics and data Management, Milan, italy
Denti, Paolo; cardiovascular imaging Unit, irccS San raffaele Hospital, Vita-Salute San raffaele University, Milan, italy ; d cardiology Unit, cardio-thoracic-Vascular department, University of Bologna, Bologna, italy
Petronio, Anna; cardiac catheterization laboratory, University of Pisa and Azienda ospedaliero-Universitaria Pisana, Pisa, italy
Marcelli, Chiara; Cardiology Unit, Cardio-Thoracic-Vascular Department, Sant’Orsola-Malpighi Hospital, University of Bologna
Bruno, Vito; department of Minimally invasive cardiac Surgery, irccS galeazzi-Sant'Ambrogio Hospital, Milan, italy
Sturla, Francesco; 3d and computer Simulation laboratory, of Electronics, information and Bioengineering, clinical and Experimental Medicine, Politecnico di Milano, Milan, Milano, italy, italy ; University of Pisa, Pisa, italy
Pugliese, Nicola; Department of Clinical and Experimental Medicine, University of Pisa
Brambilla, Nedy; department of clinical and interventional cardiology, Milan, italy
Testa, Luca; department of clinical and interventional cardiology, Milan, italy
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Bedogni, Francesco; department of clinical and interventional cardiology, Milan, italy
Tusa, Maurizio; department of clinical and interventional cardiology, Milan, italy
Evaluation of three-dimensional right ventricular function and reverse remodelling in patients undergoing percutaneous mitral valve repair for functional mitral regurgitation: insights from a multicentre Italian registry
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