Meeting News

Tricuspid valve repair improves liver function, maintains kidney function

Reduction of tricuspid regurgitation by transcatheter tricuspid edge-to-edge valve repair improved liver function and did not harm kidney function, according to data presented at EuroPCR.

Nicole Karam, MD, PhD, interventional cardiologist at European Hospital Georges Pompidou, Paris, and colleagues conducted a single-center study of 126 patients treated for tricuspid regurgitation between March 2016 and June 2018, comparing kidney and liver function at baseline, 30 days and 6 months. The results were simultaneously published in JACC: Cardiovascular Interventions.

Among the cohort, 59 patients had isolated tricuspid edge-to-edge valve repair and 67 had transcatheter mitral and tricuspid valve repair. All procedures were performed with the MitraClip (Abbott Vascular).

Among the 110 patients (87.3%) who survived to 6 months, renal function remained stable (baseline glomerular filtration rate, 37.5 mL/min/1.73 m²; 6-month glomerular filtration rate, 40.1 mL/min/1.73 m²; P = .39), according to the researchers.

Regarding liver function, alanine transaminase levels improved in survivors from 30.7 U/L at baseline to 24.9 U/L at 6 months (P < .001), Karam and colleagues found.

In the overall cohort, there were no significant differences in aspartate transaminase, gamma-glutamyl transpeptidase or bilirubin levels between baseline and 6 months.

However, among patients with abnormal baseline liver function, aspartate transaminase was reduced from 50.5 U/L at baseline to 39.9 U/L at 6 months (P = .02) and bilirubin was reduced from 1.8 mg/dL at baseline to 1.5 mg/dL at 6 months (P = .03), according to the researchers.

There were no differences between baseline and 30 days in the overall cohort except for a reduction in bilirubin (from 1.2 mg/dL to 1 mg/dL; P = .017).

“These findings highlight both the reversibility of [tricuspid regurgitation]-associated congestive hepatopathy, and the efficacy of [transcatheter tricuspid edge-to-edge valve repair] in achieving steady liver function improvement,” Karam and colleagues wrote in JACC: Cardiovascular Interventions.

Reduction of tricuspid regurgitation by transcatheter tricuspid edge-to-edge valve repair improved liver function and did not harm kidney function, according to data presented at EuroPCR.
Source: Adobe Stock

“Together with previous studies, these findings strongly argue for earlier intervention for patients with [tricuspid regurgitation] and HF, before the onset of irreversible hepatic and renal dysfunction,” Neil P. Fam, MD, MSc, director of the cardiac ICU at St. Michael’s Hospital, University of Toronto, wrote in a related editorial. “Although this approach would be expected to improve relevant clinical outcomes including mortality and HF hospitalization, this hypothesis needs to be tested in randomized clinical trials of [transcatheter tricuspid edge-to-edge valve repair] vs. optimal medical therapy, the results of which are eagerly anticipated. In the meantime, HF specialists and interventionalists alike would do well to heed abnormalities in their patients hepatorenal function, as the cost of inaction may be high.” – by Erik Swain

References:

Karam N, et al. E-Posters for Valvular Disease. Presented at: EuroPCR; May 21-24, 2019; Paris.

Fam NP. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.05.002.

Karam N, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.04.018.

Disclosures: Karam reports she received consultant fees from Abbott Vascular. Please see the study for all other authors’ relevant financial disclosures.

 

Reduction of tricuspid regurgitation by transcatheter tricuspid edge-to-edge valve repair improved liver function and did not harm kidney function, according to data presented at EuroPCR.

Nicole Karam, MD, PhD, interventional cardiologist at European Hospital Georges Pompidou, Paris, and colleagues conducted a single-center study of 126 patients treated for tricuspid regurgitation between March 2016 and June 2018, comparing kidney and liver function at baseline, 30 days and 6 months. The results were simultaneously published in JACC: Cardiovascular Interventions.

Among the cohort, 59 patients had isolated tricuspid edge-to-edge valve repair and 67 had transcatheter mitral and tricuspid valve repair. All procedures were performed with the MitraClip (Abbott Vascular).

Among the 110 patients (87.3%) who survived to 6 months, renal function remained stable (baseline glomerular filtration rate, 37.5 mL/min/1.73 m²; 6-month glomerular filtration rate, 40.1 mL/min/1.73 m²; P = .39), according to the researchers.

Regarding liver function, alanine transaminase levels improved in survivors from 30.7 U/L at baseline to 24.9 U/L at 6 months (P < .001), Karam and colleagues found.

In the overall cohort, there were no significant differences in aspartate transaminase, gamma-glutamyl transpeptidase or bilirubin levels between baseline and 6 months.

However, among patients with abnormal baseline liver function, aspartate transaminase was reduced from 50.5 U/L at baseline to 39.9 U/L at 6 months (P = .02) and bilirubin was reduced from 1.8 mg/dL at baseline to 1.5 mg/dL at 6 months (P = .03), according to the researchers.

There were no differences between baseline and 30 days in the overall cohort except for a reduction in bilirubin (from 1.2 mg/dL to 1 mg/dL; P = .017).

“These findings highlight both the reversibility of [tricuspid regurgitation]-associated congestive hepatopathy, and the efficacy of [transcatheter tricuspid edge-to-edge valve repair] in achieving steady liver function improvement,” Karam and colleagues wrote in JACC: Cardiovascular Interventions.

Reduction of tricuspid regurgitation by transcatheter tricuspid edge-to-edge valve repair improved liver function and did not harm kidney function, according to data presented at EuroPCR.
Source: Adobe Stock

“Together with previous studies, these findings strongly argue for earlier intervention for patients with [tricuspid regurgitation] and HF, before the onset of irreversible hepatic and renal dysfunction,” Neil P. Fam, MD, MSc, director of the cardiac ICU at St. Michael’s Hospital, University of Toronto, wrote in a related editorial. “Although this approach would be expected to improve relevant clinical outcomes including mortality and HF hospitalization, this hypothesis needs to be tested in randomized clinical trials of [transcatheter tricuspid edge-to-edge valve repair] vs. optimal medical therapy, the results of which are eagerly anticipated. In the meantime, HF specialists and interventionalists alike would do well to heed abnormalities in their patients hepatorenal function, as the cost of inaction may be high.” – by Erik Swain

References:

Karam N, et al. E-Posters for Valvular Disease. Presented at: EuroPCR; May 21-24, 2019; Paris.

Fam NP. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.05.002.

Karam N, et al. JACC Cardiovasc Interv. 2019;doi:10.1016/j.jcin.2019.04.018.

Disclosures: Karam reports she received consultant fees from Abbott Vascular. Please see the study for all other authors’ relevant financial disclosures.