An Imaging-Based Marker to Refine Risk Stratification for Transcatheter Mitral Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• The Tendyne™ transcatheter heart valve (THV) system offers a treatment option for severe mitral regurgitation (MR) in high-risk surgical patients.
• Fatal complications after transcatheter mitral valve replacement (TMVR) predominantly occur within 90 days post-procedure.
• Identifying anatomical predictors of in-hospital mortality is crucial for improving TMVR outcomes.

Purpose of the Study:

• To identify anatomical predictors of in-hospital mortality following transcatheter mitral valve replacement (TMVR).
• To evaluate the role of preprocedural imaging parameters in predicting outcomes after TMVR.

Main Methods:

• Subanalysis of the TENDER registry involving 110 patients who underwent TMVR between January 2020 and June 2022.
• Analysis of preprocedural imaging data, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac 4D computed tomography (CT).
• Statistical analysis to determine predictors of in-hospital mortality, including multivariate and extended models.

Main Results:

• A smaller left ventricular end-diastolic diameter index (LVEDDi) was significantly associated with in-hospital mortality (p = 0.022).
• Both indexed and absolute LVEDDi independently predicted in-hospital complications (p < 0.001 and p = 0.008, respectively).
• In multivariate analysis, LVEDDi (p = 0.048) and STS score (p = 0.038) were independent predictors of mortality; LVEDDi remained significant in an extended model (p = 0.007).

Conclusions:

• A small LVEDDi is a novel, clinically relevant risk factor for in-hospital mortality in TMVR patients.
• LVEDDi provides added value to conventional risk markers like the STS score for patient selection in TMVR.
• Incorporating LVEDDi thresholds into screening protocols can potentially improve patient selection and outcomes for TMVR.