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The prognostic value of the Dandel's index in patients undergoing tricuspid transcatheter edge-to-edge repair

Aims Conventional parameters of right ventricular (RV) function are load-dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure...

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Main Authors: Kassar, Mohammad (Author) , Brugger, Nicolas (Author) , Stolz, Lukas (Author) , Gerçek, Muhammed (Author) , Fortmeier, Vera (Author) , Kresoja, Karl-Patrik (Author) , von Stein, Jennifer (Author) , Koell, Benedikt (Author) , Rottbauer, Wolfgang (Author) , Goebel, Bjoern (Author) , Denti, Paolo (Author) , Achouh, Paul (Author) , Rassaf, Tienush (Author) , Barreiro-Perez, Manuel (Author) , Boekstegers, Peter (Author) , Rück, Andreas (Author) , Zdanyte, Monika (Author) , Adamo, Marianna (Author) , Vincent, Flavien (Author) , Schlegel, Philipp (Author) , von Bardeleben, Ralph-Stephan (Author) , Wild, Mirjam G. (Author) , Toggweiler, Stefan (Author) , Konstandin, Mathias (Author) , Van Belle, Eric (Author) , Metra, Marco (Author) , Geisler, Tobias (Author) , Estévez-Loureiro, Rodrigo (Author) , Luedike, Peter (Author) , Karam, Nicole (Author) , Maisano, Francesco (Author) , Lauten, Philipp (Author) , Kessler, Mirjam (Author) , Kalbacher, Daniel (Author) , Iliadis, Christos (Author) , Lurz, Philipp (Author) , Windecker, Stephan (Author) , Hausleiter, Jörg (Author) , Rudolph, Volker (Author) , Praz, Fabien (Author)
Format: Article (Journal)
Language:English
Published: 02 December 2024
Edition:Online version of record before inclusion in an issue
In: European journal of heart failure
Year: 2025, Volume: 27, Issue: 8, Pages: 1511-1522
ISSN:1879-0844
DOI:10.1002/ejhf.3532
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ejhf.3532
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.3532
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Author Notes:Mohammad Kassar, Nicolas Brugger, Lukas Stolz, Muhammed Gerçek, Vera Fortmeier, Karl-Patrik Kresoja, Jennifer von Stein, Benedikt Koell, Wolfgang Rottbauer, Bjoern Goebel, Paolo Denti, Paul Achouh, Tienush Rassaf, Manuel Barreiro-Perez, Peter Boekstegers, Andreas Rück, Monika Zdanyte, Marianna Adamo, Flavien Vincent, Philipp Schlegel, Ralph-Stephan von Bardeleben, Mirjam G. Wild, Stefan Toggweiler, Mathias H. Konstandin, Eric Van Belle, Marco Metra, Tobias Geisler, Rodrigo Estévez-Loureiro, Peter Luedike, Nicole Karam, Francesco Maisano, Philipp Lauten, Mirjam Kessler, Daniel Kalbacher, Christos Iliadis, Philipp Lurz, Stephan Windecker, Jörg Hausleiter, Volker Rudolph, and Fabien Praz
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Summary:Aims Conventional parameters of right ventricular (RV) function are load-dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure, but its prognostic value in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) has not been investigated so far. Methods and results From the EuroTR registry (2019 to 2022), patients with complete datasets and a minimum of 2-years of follow-up were included. RV functional parameters (i.e. tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], TAPSE/systolic pulmonary arterial pressure [sPAP]), as well as a echocardiographic RV load adaptation index (Dandel's index) were assessed and their predictive value in terms of all-cause mortality evaluated using logistic multivariate logistic regression. The majority of the 364 patients had secondary TR (96%) and were severely symptomatic (New York Heart Association class ≥III; 92%). At 2-year follow-up, 36% of patients had died. Functional RV parameters (TAPSE: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62-0.84; FAC: HR 0.73, 95% CI 0.59-0.91), coupling index (TAPSE/sPAP: HR 0.8, 95% CI 0.65-0.99) and Dandel's index (HR 0.67, 95% CI 0.53-0.85) were all associated with mortality at 2 years in univariable analyses. In a multivariate logistic regression model, the Dandel's index maintained its predictive value (p < 0.001), along with TAPSE and absence of signs of right heart failure, with an optimal threshold of 20.5 determined by the receiver-operating characteristic analysis. This threshold also successfully predicted cardiac hospital readmission. A multivariate analysis was conducted to identify parameters linked to RV function and predicting clinical outcomes. Conclusion Assessment of the RV capacity to adjust for changes in loading conditions predicted mortality in patients with severe symptomatic TR undergoing T-TEER. The use of a multiparametric approach including the Dandel's index to assess RV function had an incremental value for the stratification of patients into subgroups with different prognosis.
Item Description:Gesehen am 01.08.2025
Physical Description:Online Resource
ISSN:1879-0844
DOI:10.1002/ejhf.3532

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