The presence of right ventricular dysfunction (RVD) was unrelated to symptomatic outcomes after mitral transcatheter-edge-to-edge repair (M-TEER), according to a single-center study. These data were reported by Lukas Stolz, MD, of the University of Munich, and colleagues, in a research letter published Wednesday online in JACC: Cardiovascular Interventions. RVD, as defined by right ventricular-to-pulmonary artery coupling (RVPAc), has been identified as a mortality predictor after M-TEER, although little is known about the impact of RVD on symptomatic reduction. Therefore, this study aimed to evaluate the impact of baseline RVD on symptomatic outcomes after M-TEER for mitral regurgitation. The study included patients who underwent M-TEER from 2015 to 2022 at a high-volume center in Germany and had available data on 6-minute walk distance (6MWD), Minnesota Living With Heart Failure Questionnaire (MLHFQ) score, and New York Heart Association (NYHA) functional class at both baseline and follow-up. Symptomatic reduction was evaluated according to the presence of RVD, defined as an RVPAc ratio (tricuspid annular plane systolic excursion [TAPSE]/systolic pulmonary artery pressure) <0.274 mm/mmHg. The Wilcoxon test was used for comparison of paired samples. The study included 375 patients, of whom 163 (43.5%) were women (mean age 77.1 ± 9.5 years), with a median follow-up time of 513 days (interquartile range: 251-998 days). Mitral regurgitation (MR) etiology was secondary in 47.2% and primary or mixed in 52.8%. The mean left ventricular ejection fraction was 47.6% ± 14.5%. The mean RVPAc ratio was 0.444 ± 0.210 mm/mmHg, indicating RVD, in 17.1% of patients. Paired information at baseline and follow-up on NYHA functional class were available in 371 patients, on MLHFQ score in 181 and on 6MWD in 223. At baseline, there were no statistical differences in quality of life (QOL), RVD, MLHFQ, 6MWD, or NYHA functional class >3. Regarding the study findings, there was no statistically significant change in MLHFQ score in patients with RVD (from 36 ± 17 to 29 ± 19 points, absolute change -8 points); P = 0.196). Only in patients without RVD did the improvement in MLHFQ score achieved statistical significance (from 36 ± 17 to 28 ± 19 points, absolute change -8 points; P = 0.002). There was a statistically significant increase in 6MWD irrespective of presence of RVD from baseline to follow-up, although there was no significant difference between the RVD and no-RVD groups at follow-up (P = 0.857). Improvement in NYHA functional class reached statistical significance in patients both with and without RVD. Improvements in NYHA functional class, 6MWD, and MLHFQ score did not differ whether MR etiology was primary/mixed primary or secondary. At follow-up, a significant improvement in RVPAc ratio was observed (from 0.444 ± 0.210 mm/mmHg to 0.538 ± 0.250 mm/mmHg; P <0.001), driven primarily by a reduction in systolic pulmonary artery pressure, while TAPSE remained unchanged. The improvement was more pronounced in patients with RVD (0.078 ± 0.291 mmHg vs. 0.177 ± 0.162 mmHg in patients without RVD). Two-year survival rates were 80.1% in patients with RVD and 87.5% in patients without RVD. Limitations of this study included selection bias from exclusion of patients with symptomatic outcomes at baseline and follow-up and no echocardiography core lab adjudication. In summary, this real-world study reported symptomatic outcomes after M-TEER by presence of RVD, finding substantial improvements in QOL and exercise capacity and reduction in exertional dyspnea after M-TEER regardless of baseline right ventricular function. Of note, patients with RVD did not exhibit significant MLHFQ improvement, although they showed a trend toward improvement, and patients with preserved right ventricular function showed a trend toward improved survival. Source: Stolz L, Doldi PM, Weckbach LT, et al. Impact of Right Ventricular Dysunction on Symptomatic Outcomes After Transcatheter Mitral Valve Repair. JACC Cardiovasc Interv. 2023 Dec 20 (Article in press). Image Credit: magicmine – stock.adobe.com