The Impact of Concomitant Mitral Regurgitation on Echocardiography Parameters After TransCatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
Bahar Darouei
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorCorresponding Author
Reza Amani-Beni
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Correspondence: Reza Amani-Beni ([email protected])
Search for more papers by this authorMehrdad Rabiee Rad
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorGhazal Ghasempour Dabaghi
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorReza Eshraghi
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorAshkan Bahrami
Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
Search for more papers by this authorEhsan Amini-Salehi
Guilan University of Medical Sciences, Rasht, Iran
Search for more papers by this authorSeyyed Mohammad Hashemi
Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Search for more papers by this authorSadegh Mazaheri-Tehrani
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorMohammad Reza Movahed
Department of Medicine, University of Arizona College of Medicine, Phoenix, USA
Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona, USA
Search for more papers by this authorBahar Darouei
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorCorresponding Author
Reza Amani-Beni
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Correspondence: Reza Amani-Beni ([email protected])
Search for more papers by this authorMehrdad Rabiee Rad
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorGhazal Ghasempour Dabaghi
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorReza Eshraghi
Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorAshkan Bahrami
Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
Search for more papers by this authorEhsan Amini-Salehi
Guilan University of Medical Sciences, Rasht, Iran
Search for more papers by this authorSeyyed Mohammad Hashemi
Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
Search for more papers by this authorSadegh Mazaheri-Tehrani
Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
Search for more papers by this authorMohammad Reza Movahed
Department of Medicine, University of Arizona College of Medicine, Phoenix, USA
Department of Medicine, University of Arizona Sarver Heart Center, Tucson, Arizona, USA
Search for more papers by this authorABSTRACT
Background
Mitral regurgitation (MR) commonly coexists with aortic stenosis (AS) and is a potential risk factor influencing outcomes following transcatheter aortic valve replacement (TAVR). This meta-analysis aimed to evaluate the mean changes in key echocardiographic parameters before and after TAVR and to compare these changes between patients with moderate-to-severe MR (MR ≥ 2) and those with none-to-mild MR (MR < 2).
Methods
A comprehensive literature search was conducted using six electronic databases. We included studies that evaluated patients undergoing TAVR, classified them based on baseline MR grade ≥ 2 (moderate/severe MR) or MR grade < 2 (none/mild MR), and reported the mean difference (MD) in echocardiographic parameters before and after TAVR in both groups. The primary outcomes included changes in ejection fraction (EF), LV end-diastolic volume (LVEDV) index, LV end-systolic volume (LVESV) index, LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), aortic valve area (AVA), and the mean aortic gradient. Pooled MDs were analyzed using a random-effects model.
Results
Thirteen studies with 7163 patients were included, of which 2376 had an MR ≥ 2. The MR < 2 and MR ≥ 2 groups experienced significant improvements in AVA and reductions in mean aortic gradient, LVEDV index, LVESV index, LVEDD, and LVESD. Compared to MR < 2 patients, those with MR ≥ 2 exhibited significantly greater improvements in EF (MD = 2.03; 95% CI: 0.81, 3.24), LVEDV index (MD = −5.55; 95% CI: −7.85, −3.26), LVESV index (MD = −5.43; 95% CI: −7.28, −3.58), LVESD (MD = −2.23; 95% CI: −3.71, −0.26), and mean aortic gradient (MD = 1.43; 95% CI: 0.79, 2.07). However, the changes in LVEDD and AVA were not significantly different between the groups.
Conclusions
These findings suggest that patients with moderate-to-severe baseline MR before TAVR showed greater pronounced improvements in specific echocardiographic parameters related to LV function and geometry, particularly in LVEF, LVEDV index, LVESV index, and LVESD, compared to those with none-to-mild MR. Future studies should focus on stratifying outcomes according to MR etiology and using advanced imaging techniques to delineate better the mechanisms underlying these improvements.
Conflicts of Interest
The authors declare no conflict of interest.
Open Research
Data Availability Statement
The authors have nothing to report.
Supporting Information
| Filename | Description |
|---|---|
| ccd31555-sup-0001-Supplementary_Material.docx302.2 KB | Table S1: Search strategy Table S2: Results of the pooled analysis between patients with pre-TAVR MR ≥ 2 and those with MR < 2. Figure S1-S7: Forest plots for the MD of change-from-baseline EF, LVEDV index, LVESV index, LVEDD, LVESD, AVA, and mean aortic gradient between those with pre-TAVR MR ≥ 2 and patients with pre-TAVR MR < 2. Figure S8-14: Leave-one-out sensitivity plot of the mean difference for EF, LVEDV index, LVESV index, LVEDD, LVESD, AVA, and mean aortic gradient in patients with pre-TAVR MR ≥ 2 vs. MR < 2. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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