Insulin-Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2024-11-26 DOI:10.1002/clc.70048

Matthias Gröger, Dominik Felbel, Michael Paukovitsch, Leonhard Moritz Schneider, Sinisa Markovic, Wolfgang Rottbauer, Mirjam Keßler

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Abstract

Background

Concomitant right ventricular (RV) failure and tricuspid regurgitation (TR) are common comorbidities in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) and are associated with worse prognosis. Improvement of TR after M-TEER occurs frequently, however determinants of this course are poorly understood. This study aimed to analyze serum biomarkers that are differentially regulated in patients with TR and to identify biomarkers predictive of the course of TR after M-TEER.

Methods and Results

Biomarker expression was analyzed in 242 prospectively included patients undergoing M-TEER. Patients with moderate-to-severe TR had significant comorbidities (median EuroSCORE II 5.2 in patients with severe TR, 4.9 in moderate TR, 3.2 in no/mild TR; p = 0.002) and a large number of biomarkers was upregulated including IGFBP-2 (1.4-fold in severe TR compared to no/mild TR, p = 0.005). Echocardiographic follow-up 3 months after M-TEER was carried out in 99 patients. RV reverse remodeling (RVRR) as defined by improvement of concomitant TR by at least one grade and/or RV diameter downsizing of at least 10% compared to baseline was seen in 50 patients (50.5%). IGFBP-2 (Odds Ratio 2.078) and presence of chronic pulmonary disease (Odds Ratio 15.341) proved independent predictors of non-development of RVRR within 3 months after M-TEER.

Conclusions

In patients undergoing M-TEER with concomitant moderate or severe TR, numerous cardiometabolic biomarkers including IGFBP-2 are upregulated. Higher levels of IGFBP-2 at baseline are independently associated with persistent TR and/or RV dilation after M-TEER.

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胰岛素样生长因子结合蛋白 2 预测经导管边对边二尖瓣修复术后右心室反向重塑和并发三尖瓣反流的改善。

背景：并发右心室（RV）衰竭和三尖瓣反流（TR）是二尖瓣经导管边缘到边缘修补术（M-TEER）患者的常见并发症，与较差的预后有关。M-TEER术后二尖瓣反流的改善是经常发生的，但这一过程的决定因素却鲜为人知。本研究旨在分析TR患者血清中受到不同调控的生物标志物，并确定可预测M-TEER术后TR病程的生物标志物：对242名接受M-TEER的前瞻性纳入患者的生物标志物表达进行了分析。中重度TR患者有明显的合并症（重度TR患者的EuroSCORE II中位数为5.2，中度TR患者为4.9，无/轻度TR患者为3.2；P = 0.002），大量生物标志物上调，包括IGFBP-2（重度TR患者的IGFBP-2是无/轻度TR患者的1.4倍，P = 0.005）。对 99 例患者进行了 M-TEER 术后 3 个月的超声心动图随访。50例患者（50.5%）出现了RV反向重塑（RVRR），其定义是与基线相比，伴随的TR至少改善了一个等级和/或RV直径缩小了至少10%。事实证明，IGFBP-2（Odds Ratio 2.078）和慢性肺部疾病（Odds Ratio 15.341）是 M-TEER 术后 3 个月内不出现 RVRR 的独立预测因素：结论：在接受M-TEER手术并同时伴有中度或重度TR的患者中，包括IGFBP-2在内的多种心脏代谢生物标志物都会上调。基线IGFBP-2水平较高与M-TEER后持续TR和/或RV扩张有独立关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.