Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

Stolz, Lukas; Doldi, Philipp M; Orban, Mathias; Karam, Nicole; Puscas, Tania; Wild, Mirjam G; Popescu, Aniela; von Bardeleben, Ralph Stephan; Iliadis, Christos; Baldus, Stephan; Adamo, Marianna; Thiele, Holger; Besler, Christian; Unterhuber, Matthias; Ruf, Tobias; Pfister, Roman; Higuchi, Satoshi; Koell, Benedikt; Giannini, Christina; Petronio, Anna; ... (2023). Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. JACC. Cardiovascular Interventions, 16(2), pp. 140-151. Elsevier 10.1016/j.jcin.2022.10.032

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BACKGROUND

Secondary mitral regurgitation (SMR) is a progressive disease with characteristic pathophysiological changes that may influence prognosis. Although the staging of SMR patients suffering from heart failure with reduced ejection fraction (HFrEF) according to extramitral cardiac involvement has prognostic value in medically treated patients, such data are so far lacking for edge-to-edge mitral valve repair (M-TEER).

OBJECTIVES

This study sought to classify M-TEER patients into disease stages based on the phenotype of extramitral cardiac involvement and to assess its impact on symptomatic and survival outcomes.

METHODS

Based on echocardiographic and clinical assessment, patients were assigned to 1 of the following HFrEF-SMR groups: left ventricular involvement (Stage 1), left atrial involvement (Stage 2), right ventricular volume/pressure overload (Stage 3), or biventricular failure (Stage 4). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on 2-year all-cause mortality. The symptomatic outcome was assessed with New York Heart Association functional class at follow-up.

RESULTS

Among a total of 849 eligible patients who underwent M-TEER for relevant SMR from 2008 until 2019, 9.5% (n = 81) presented with left ventricular involvement, 46% (n = 393) with left atrial involvement, 15% (n = 129) with right ventricular pressure/volume overload, and 29% (n = 246) with biventricular failure. An increase in HFrEF-SMR stage was associated with increased 2-year all-cause mortality after M-TEER (HR: 1.39; CI: 1.23-1.58; P < 0.01). Furthermore, higher HFrEF-SMR stages were associated with significantly less symptomatic improvement at follow-up.

CONCLUSIONS

The classification of M-TEER patients into HFrEF-SMR stages according to extramitral cardiac involvement provides prognostic value in terms of postinterventional survival and symptomatic improvement.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Windecker, Stephan, Praz, Fabien Daniel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

27 Jan 2023 15:13

Last Modified:

27 Jan 2023 23:27

Publisher DOI:

10.1016/j.jcin.2022.10.032

PubMed ID:

36697148

Uncontrolled Keywords:

edge-to-edge-repair heart failure secondary mitral regurgitation staging

URI:

https://boris.unibe.ch/id/eprint/177919

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