Abstract 16152: Changes in Tricuspid Regurgitation and Right Heart Hemodynamics After MitraClip for Reduction of Functional Mitral Regurgitation
Introduction: A large proportion of individuals with longstanding functional mitral regurgitation (MR) have significant tricuspid regurgitation (TR) due to secondary right ventricular (RV) dilation. Little is known about changes in right sided chamber size and pressure post MitraClip for functional MR.
Hypothesis: Individuals with significant MR reduction post MitraClip might have lower RV systolic pressures, decrease in TR severity and possibly improved RV size and function.
Methods: We performed quantitative TTE analysis of RV and TR parameters on the 112 individuals with functional MR analyzed at the UCSF echo core lab within the EVEREST II REALISM study at baseline and 12 months after clip. Changes in right sided parameters were assessed with respect to MR reduction.
Results: At baseline 63% had moderate or severe TR. At 1 year, MR reduction occurred in 88 individuals (78.6%) with 31 (35.2%) having 2 or more grades of MR reduction. Of those with MR reduction, 23 (26.1%) had improvement in TR by ≥1 grades, but most had no change in TR or increased TR at 12 months. There was no significant association between reduction in MR and reduction in TR across groups of MR reduction (none, 1-2 grades reduction or >2 grades). The degree of MR reduction did not relate to changes in diastolic and systolic tricuspid annulus diameter, RA area, RV diameter, or RVSP. Among the subset of 24 subjects with severe TR at baseline, 20 had improvement of MR. Those who improved to mild or moderate TR had an average MR reduction of 1.5 grades (N = 13) compared to a 1.0 grade MR reduction in those whose TR remained severe (N = 11), but the difference was not statistically significant (p value = 0.19).
Conclusions: In patients with functional MR, MitraClip reduces MR but does not consistently reduce TR, RV size or RVSP, suggesting other factors may continue to right sided disease. Further study is needed to better identify those who may benefit from additional percutaneous therapies aimed at reducing concomitant TR.
Author Disclosures: K.C. Eriksen: None. D.S. Lim: Research Grant; Significant; Abbott Vascular. T. Feldman: Honoraria; Significant; Abbott Vascular, Boston Scientific, Edwards, WL Gore. Consultant/Advisory Board; Significant; Abbott Vascular, Boston Scientific, Edwards, WL Gore. L. Crosson: Employment; Significant; Abbott Vascular. J. Ellis: Employment; Significant; Abbott Vascular. S. Kar: Honoraria; Significant; Abbott Vascular, Boston Scientific. Consultant/Advisory Board; Significant; Abbott Vascular, Boston Scientific. E. Foster: Research Grant; Significant; Abbott Vascular. Consultant/Advisory Board; Significant; Gilead. A. Qasim: Other Research Support; Significant; Abbott Vascular.
- © 2016 by American Heart Association, Inc.