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Outcome Prediction Score for Mitral Transcatheter Edge-to-Edge Repair in Patients with Concomitant Significant Tricuspid Regurgitation

Hellenic J Cardiol. 2023 Sep 9:S1109-9666(23)00155-0. doi: 10.1016/j.hjc.2023.09.006. Online ahead of print.


BACKGROUND: – Tricuspid regurgitation (TR) adversely affects prognosis following mitral transcatheter edge-to-edge repair (TEER). We aimed to derive a risk stratification tool for patients undergoing TEER for mitral regurgitation while exhibiting significant TR.

METHODS: – This is a single-center, retrospective analysis of 217 consecutive individuals referred to an isolated mitral TEER who had moderate-to-severe or greater TR at baseline. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalizations. The cohort was randomly split in a 75%-to-25% ratio, creating train (n=163) and test (n=54) datasets. Model development, discrimination and calibration were based on the train dataset. Internal validation was applied to the test dataset.

RESULTS: – Overall, 81 (37.3%) patients experienced the primary outcome. After multivariable analysis, a score for predicting the primary outcome was constructed that utilized a 0-to-3 scale, in which each point represented one of three baseline variables independently associated with this combined endpoint: serum B-natriuretic peptide (BNP) level >1,000 pg/mL, qualitative right ventricular (RV) dysfunction on transthoracic echocardiogram, and cardiac implantable electronic device (CIED). C-statistic of the model was 0.66 (95% CI, 0.57-0.75, p=0.002) and 0.75 (95% CI, 0.61-0.89, p=0.004) in the train and test datasets, respectively – representing comparable performance to current, more complex tools. Neither this BNP-RV-CIED (BRC) score nor other models were prognostically meaningful in 32 patients excluded from the main analysis who underwent a combined mitral-tricuspid TEER.

CONCLUSION: – The BRC score is a simple clinical prediction tool that may aid in the triage of isolated mitral TEER candidates with significant pre-existing TR.

PMID:37696418 | DOI:10.1016/j.hjc.2023.09.006

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