Back to Search Start Over

Congestion patterns in severe tricuspid regurgitation and transcatheter treatment: Insights from a multicentre registry.

Authors :
Rommel, Karl‐Philipp
Bonnet, Guillaume
Fortmeier, Vera
Stolz, Lukas
Schöber, Anne R.
von Stein, Jennifer
Kassar, Mohammad
Gerçek, Muhammed
Rosch, Sebastian
Stocker, Thomas J.
Körber, Maria I.
Kresoja, Karl‐Patrik
Rudolph, Tanja K.
Pfister, Roman
Baldus, Stephan
Windecker, Stephan
Thiele, Holger
Praz, Fabien
Hausleiter, Jörg
Rudolph, Volker
Source :
European Journal of Heart Failure; Apr2024, Vol. 26 Issue 4, p1004-1014, 11p
Publication Year :
2024

Abstract

Aims: While invasively determined congestion holds mechanistic and prognostic significance in acute heart failure (HF), its role in patients with tricuspid regurgitation (TR)‐related right‐ heart failure (HF) undergoing transcatheter tricuspid valve intervention (TTVI) is less well established. A comprehensive understanding of congestion patterns might aid in procedural planning, risk stratification, and the identification of patients who may benefit from adjunctive therapies before undergoing TTVI. The aim of this study was to investigate the role of congestion patterns in patients with severe TR and its implications for TTVI. Methods and results: Within a multicentre, international TTVI registry, 813 patients underwent right heart catheterization (RHC) prior to TTVI and were followed up to 24 months. The median age was 80 (interquartile range 76–83) years and 54% were women. Both mean right atrial pressure (RAP) and pulmonary capillary wedge pressure (PCWP) were associated with 2‐year mortality on Cox regression analyses with Youden index‐derived cut‐offs of 17 mmHg and 19 mmHg, respectively (p < 0.01 for all). However, RAP emerged as an independent predictor of outcomes following multivariable adjustments. Pre‐interventionally, 42% of patients were classified as euvolaemic (RAP <17 mmHg, PCWP <19 mmHg), 23% as having left‐sided congestion (RAP <17 mmHg, PCWP ≥19 mmHg), 8% as right‐sided congestion (RAP ≥17 mmHg, PCWP <19 mmHg), and 27% as bilateral congestion (RAP ≥17 mmHg, PCWP ≥19 mmHg). Patients with right‐sided or bilateral congestion had the lowest procedural success rates and shortest survival times. Congestion patterns allowed for discerning specific patient's physiology and specifying prognostic implications of right ventricular to pulmonary artery coupling surrogates. Conclusion: In this large cohort of invasively characterized patients undergoing TTVI, congestion patterns involving right‐sided congestion were associated with low procedural success and higher mortality rates after TTVI. Whether pre‐interventional reduction of right‐sided congestion can improve outcomes after TTVI should be established in dedicated studies. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
13889842
Volume :
26
Issue :
4
Database :
Complementary Index
Journal :
European Journal of Heart Failure
Publication Type :
Academic Journal
Accession number :
177562900
Full Text :
https://doi.org/10.1002/ejhf.3235