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Stolz, Lukas; Orban, Mathias; Besler, Christian; Kresoja, Karl-Patrik; Braun, Daniel; Doldi, Philipp; Orban, Martin; Hagl, Christian; Rommel, Karl-Philipp; Mayerle, Julia; Hausleiter, Sebastian; Loew, Kornelia; Higuchi, Satoshi; Wild, Mirjam; Unterhuber, Matthias; Massberg, Steffen; Naebauer, Michael; Thiele, Holger; Lurz, Philipp und Hausleiter, Joerg (2022): Cardiohepatic Syndrome Is Associated With Poor Prognosis in Patients Undergoing Tricuspid Transcatheter Edge-to-Edge Valve Repair. In: JACC Cardiovascular Interventions, Bd. 15, Nr. 2: S. 179-189

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Abstract

OBJECTIVES The aim of this study was to evaluate the prevalence and prognostic implications of cardiohepatic syndrome (CHS) in patients with tricuspid regurgitation (TR) treated with tricuspid transcatheter edge-to-edge valve repair (T-TEER). BACKGROUND The role of CHS in patients undergoing T-TEER for severe TR has not been studied. METHODS This study included patients who underwent T-TEER for TR between 2016 and 2020 at 2 high-volume academic centers. CHS was defined as elevation of at least 2 of 3 cholestatic hepatic enzymes. The impact of CHS on 1-year all-cause mortality and clinical outcomes after T-TEER was investigated. RESULTS T-TEER reduced TR severity to <= 2+in 257 of 305 included patients (86.2%). CHS was present in 45.2% of patients and was associated with a higher rate of mortality and of first hospitalization for heart failure (HHF) (CHS vs no CHS: estimated 1-year mortality, 34.0% vs 15.9% [P < 0.01];HHF, 23.0% vs 12.2% [P = 0.01]). CHS was identified as an independent predictor of 1-year all-cause mortality (HR: 1.86;95% CI: 1.10-3.14;P < 0.05). Irrespective of CHS, T-TEER improved New York Heart Association functional class and 6-minute walk distance in the majority of patients. In patients with impaired baseline hepatic function, laboratory liver parameters improved after T-TEER. CONCLUSIONS CHS is a strong predictor of mortality and HHF after T-TEER and should be evaluated in the process of procedural decision making for T-TEER. Nevertheless, T-TEER is associated with relevant symptomatic alleviation irrespective of CHS. (C) 2022 by the American College of Cardiology Foundation.

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