Impact of Tricuspid Regurgitation on Clinical Outcomes Following M-TEER for Primary Mitral Regurgitation: Results from the PRIME-MR Registry

S. Ludwig (Hamburg)¹, A. Scotti (New York)², B. Köll (Hamburg)¹, D. Feldman (New York)³, A. Araujo Adams (New York)⁴, D. Patel (Los Angeles)⁵, D. Samim (Bern)⁶, C. Giannini (Pisa)⁷, J. Dreyfus (Saint-Denis)⁸, J.-M. Paradis (Quebec)⁹, Y. Bohbot (Amiens)¹⁰, A. Bernard (Tours)¹¹, A. Quagliana (Copenhagen)¹², Y. Lavie-Badie (Toulouse)¹³, M. Keßler (Ulm)¹⁴, O. Chehab (London)¹⁵, S. Redwood (London)¹⁶, E. Lubos (Hamburg)¹⁷, O. De Backer (Copenhagen)¹⁸, M. Metra (Brescia)¹⁹, M. Weber (Bonn)²⁰, T. K. Rudolph (Bad Oeynhausen)²¹, C. Iliadis (Köln)²², F. Praz (Bern)²³, M. Gercek (Bad Oeynhausen)²¹, E. Xhepa (München)²⁴, G. Nickenig (Bonn)²⁰, R. Makkar (Californien)²⁵, J. Hausleiter (München)²⁶, E. Donal (Rennes)²⁷, J. Granada (New York)²⁸, T. Modine (Bordeaux)²⁹, A. Coisne (Lille)³⁰, A. Latib (Ney York)³¹, D. Kalbacher (Hamburg)^32
1Universitäres Herz- und Gefäßzentrum Hamburg Klinik für Kardiologie Hamburg, Deutschland; ²Montefiore Medical Center, Albert Einstein College of Medicine Montefiore-Einstein Center for Heart and Vascular Care New York, USA; ³Montefiore Medical Center Cardiology New York, USA; ⁴Montefiore Medical Center Cardiology New York, Deutschland; ⁵Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA Los Angeles, USA; ⁶Inselspital - Universitätsspital Bern Bern, Schweiz; ⁷University of Pisa Pisa, Italien; ⁸Centre Cardiologique du Nord Department of Cardiology Saint-Denis, Frankreich; ⁹Laval University Quebec Heart & Lung Institute Quebec, Kanada; ¹⁰Amiens University Hospital Department of Cardiology Amiens, Frankreich; ¹¹CHRU de Tours Cardiology Department Tours, Frankreich; ¹²Rigshospitalet, Copenhagen University Hospital Copenhagen Copenhagen, Dänemark; ¹³Rangueil University Hospital Department of Cardiology Toulouse, Deutschland; ¹⁴Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; ¹⁵St. Thomas' Hospital Department of Cardiology London, Großbritannien; ¹⁶St. Thomas' Hospital Department of Cardiology London, Deutschland; ¹⁷Katholisches Marienkrankenhaus gGmbH Kardiologie und Angiologie Hamburg, Deutschland; ¹⁸University hospital Copenhagen Copenhagen, Dänemark; ¹⁹University of Brescia Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Brescia, Italien; ²⁰Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; ²¹Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ²²Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; ²³Inselspital - Universitätsspital Bern Universitätsklinik für Kardiologie Bern, Schweiz; ²⁴Deutsches Herzzentrum München Klinik für Herz- und Kreislauferkrankungen München, Deutschland; ²⁵Cedars-Sinai Medical Center Californien, USA; ²⁶LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; ²⁷University of Rennes CHU Rennes, Inserm, LTSI - UMR 1099 Rennes, Frankreich; ²⁸Cardiovascular Research Foundation New York, Deutschland; ²⁹Centre Hospitalier Universitaire Bordeaux Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle Bordeaux, Frankreich; ³⁰Heart Valve Clinic, CHU Lille Department of Clinical Physiology and Echocardiography Lille, Frankreich; ³¹Montefiore Medical Center, Albert Einstein College of Medicine Montefiore-Einstein Center for Heart and Vascular Care Ney York, USA; ³²Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland

Background: The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation (PMR).

Aims: This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with PMR undergoing mitral transcatheter edge-to-edge repair (M-TEER).

Methods: The PRIME-MR registry included 3,083 patients with severe PMR undergoing M-TEER in 2008-2022 at 25 international sites. Only patients with successful M-TEER procedures (MR≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) vs TR≥Severe (TR≥Sev). The primary endpoint was 2-year all-cause mortality.

Results: A total of 2,155 patients were analyzed: TR≥Sev (n=421 [20%]) vs. TR≤Mod (n=1,734 [80%]). Patients with TR≥Sev were more likely to be NYHA III/IV (P=0.003), have shorter 6-minute walk distance (P<0.001), higher NT-proBNP (P<0.001), higher creatinine (P<0.001), higher pulmonary artery pressures (P<0.001), atrial fibrillation (P<0.001), and more diuretics (P<0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% vs. 19.6%, P_log-rank<0.0001) and Heart Failure hospitalization (21.1% vs. 16.8%, P_Gray=0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (Adj-HR 1.77 [1.22-2.58], P=0.0029). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% vs. 19.9%, P_log-rank=0.0037) than TR≤Mod.

Conclusions: In the PRIME-MR Registry, one of every five patients with PMR had severe TR at baseline. TR Severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2-years.