Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair.

Orban, Mathias; Karam, Nicole; Lubos, Edith; Kalbacher, Daniel; Braun, Daniel; Deseive, Simon; Neuss, Michael; Butter, Christian; Praz, Fabien; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Lurz, Philipp; Thiele, Holger; Baldus, Stephan; Stephan von Bardeleben, Ralph; Blankenberg, Stefan; Massberg, Steffen; ... (2020). Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair. (In Press). JACC. Cardiovascular imaging Elsevier 10.1016/j.jcmg.2020.05.042

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OBJECTIVES

The purpose of this paper was to evaluate the impact of proportionality of secondary mitral regurgitation (SMR) in a large real-world registry of transcatheter edge-to-edge mitral valve repair (TMVr) BACKGROUND: Differences in the outcomes of recent randomized trials of TMVr for SMR may be explained by the proportionality of SMR severity to left ventricular (LV) volume.

METHODS

The ratio of pre-procedural effective regurgitant orifice area (EROA) to LV end-diastolic volume (LVEDV) was retrospectively assessed in patients undergoing TMVr for severe SMR between 2008 and 2019 from the EuroSMR registry. A recently proposed SMR proportionality scheme was adapted to stratify patients according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD), MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was assessed as a primary outcome, secondary heart failure (HF) outcomes included hospitalization for HF (HHF), New York Heart Association (NYHA) functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP), 6-min-walk distance, quality of life and MR grade.

RESULTS

A total of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months after TMVr. MR was reduced to grade ≤2+ in 92%, 96%, and 94% of patients (for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for covariates including age, sex, diabetes, kidney function, body surface area, LV ejection fraction, and procedural MR reduction (grade ≤2+), adjusted rates of 2-year mortality in MD patients did not differ from those for MLCD patients (17% vs. 18%, respectively), whereas it was higher in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD; p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD, 82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class was seen in all groups (p < 0.001). Values for 6-min-walk distances, quality of life and NT-proBNP improved in most patients.

CONCLUSIONS

MD and MLCD patients had a comparable, adjusted 2-year mortality rate after TMVr which was slightly better than that of LD patients. Patients treated with TMVr had symptomatic improvement regardless of EROA/LVEDV ratio.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Praz, Fabien; Kassar, Mohammad and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1936-878X

Publisher:

Elsevier

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

18 Nov 2020 11:04

Last Modified:

05 Dec 2020 01:33

Publisher DOI:

10.1016/j.jcmg.2020.05.042

PubMed ID:

32861652

Uncontrolled Keywords:

MR proportionality echocardiography heart failure secondary mitral regurgitation transcatheter mitral valve repair

BORIS DOI:

10.7892/boris.147458

URI:

https://boris.unibe.ch/id/eprint/147458

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