ReRISE: Renal Resistive Index as a Stratification Element in M-TEER Outcomes

Clin Res Cardiol (2025). DOI 10.1007/s00392-025-02737-x

Hannah Billig (Bonn)1, S. Hofmann (Düsseldorf)2, M. A. Rogmann (Mainz)3, J. Vogelhuber (Bonn)1, M. U. Becher (Solingen)4, G. Nickenig (Bonn)1, C. Öztürk (Bonn)1

1Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 2Heinrich-Heine-Universität Düsseldorf Düsseldorf, Deutschland; 3Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 4Städt. Klinikum Solingen gGmbH Klinik für Kardiologie und internistische Intensivmedizin Solingen, Deutschland

 

Background:
The renal resistive index (RRI) is increasingly recognised as a non-invasive marker of cardiorenal interaction. We aimed to determine (i) whether baseline RRI predicts survival after mitral transcatheter edge-to-edge repair (M-TEER) and (ii) how RRI changes in response to the procedure.

Methods:
In this prospective, single-centre cohort we enrolled consecutive patients with severe mitral regurgitation who underwent M-TEER between October 2020 and December 2021. Baseline demographics, estimated glomerular filtration rate (eGFR), comprehensive echocardiography, and Doppler-derived RRI were collected before intervention and repeated at three-month follow-up. The primary endpoint was all-cause mortality. Associations were analysed with multivariable Cox regression.

Results:
Among 109 patients (53.2 % women), the median baseline RRI was 0.71 (IQR 0.67–0.75) and showed no correlation with eGFR, left-ventricular ejection fraction, or residual mitral regurgitation at discharge. A baseline RRI > 0.70 independently predicted all-cause mortality (p = 0.027). RRI improved significantly three months after M-TEER (0.67; IQR 0.63–0.70; p < 0.001). However, the change in RRI showed no correlation with either the degree of mitral-regurgitation improvement or mortality.

Conclusion:
A baseline RRI > 0.70 identifies patients at increased risk of death after M-TEER, independent of renal function and conventional echocardiographic indices. RRI may therefore complement existing parameters for pre-procedural risk stratification in this population.

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