https://doi.org/10.1007/s00392-024-02526-y
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland; 3Inselspital - Universitätsspital Bern Universitätsklinik für Kardiologie Bern, Schweiz
Background
Mitral regurgitation is the second most treated valvular pathology in Europe. The gold standard for treatment of mitral valve disease is surgical repair or replacement, if repair is not applicable. However, especially in older and morbid patients, cardiac surgery is associated with an elevated perioperative risk. Therapeutic options for an interventional approach include transcatheter edge-to-edge repair for mitral regurgitation and transcatheter mitral valve replacement (TMVR) with the TENDYNE prothesis (Abbott Vascular, California, USA). The accurate selection of the appropriate therapeutic approach for each individual patient is challenging and requires comprehensive diagnostics and interdisciplinary evaluation in a heart valve conference.
Objective:
With this study we analyze basic echocardiographic parameters for cardiac dimensions to predict eligibility of TMVR.
Methods:
For this retrospective analysis, we included all patients referred for the evaluation of TMVR eligibility 01/2020 and 01/2023. All patients underwent echocardiographic assessment prior to intervention. Statistical analysis was performed using R, and a logarithmic regression model was employed.
Results:
106 patients were included in this analysis, of whom 35 were accepted and 71 refused for TMVR. Baseline demographic data and cardiac comorbidities were comparable. Both groups included patients evaluated for mitral stenosis or combined mitral valve disease, with comparable distributions between the groups. Notable differences included a higher percentage of prior cardiothoracic surgery, a higher STS-Score and worse renal function in the accepted patients. Of the refused patients, 38 (53.5%) were treated conservatively, 31 (43.7%) underwent surgical replacement and 2 (2.8%) received M-TEER.
Logarithmic regression identified four statistically significant parameters: LVEF (Estimate = -0.06, p-value = 0.008, sensitivity = 0.58, specificity = 0.70, accuracy = 0.69, odds ratio = 0.94), LVESD (Estimate = 0.009, p-value = 0.03, sensitivity = 0.56, specificity = 0.69, accuracy = 0.68, odds ratio = 1.01), LVEDV (Estimate = 0.06, p-value = 0.006, sensitivity = 0.63, specificity = 0.69, accuracy = 0.60, odds ratio = 1.06), and LVESV (Estimate = 0.01, p-value = 0.02, sensitivity = 0.54, specificity = 0.70, accuracy = 0.68, odds ratio = 1.01).
Conclusion:
Four echocardiographic parameters were identified that showed significant differences between the groups: LVEF, LVESD, LVEDV and LVESV. Surprisingly, these parameters suggest patients with a larger LV were more likely to be accepted for TMVR. This might be attributed to the inclusion of mitral stenosis and combined mitral valve disease patients, even though distribution was comparable between both groups. When isolated mitral regurgitation patients were analyzed, no statistical significance was found for any analyzed echocardiographic parameters. Also, the odds ratios for the identified parameters were not considered of clinical importance. In conclusion, we did not identify basic echocardiographic parameters to predict acceptance for TMVR with this analysis. More detailed echocardiographic analyses such as MVQ-analysis seem to be necessary to predict feasibility of TMVR.