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