Cardio-hepatic syndrome in patients undergoing transcatheter mitral valve edge-to-edge repair.

Stolz, Lukas; Orban, Mathias; Karam, Nicole; Lubos, Edith; Wild, Mirjam; Weckbach, Ludwig; Stocker, Thomas J; Praz, Fabien; Braun, Daniel; Löw, Kornelia; Hausleiter, Sebastian; Stark, Konstantin; Doldi, Philipp; Tence, Noemie; Orban, Martin; Higuchi, Satoshi; Haum, Magda; Windecker, Stephan; Hagl, Christian; Mayerle, Julia; ... (2023). Cardio-hepatic syndrome in patients undergoing transcatheter mitral valve edge-to-edge repair. European journal of heart failure, 25(6), pp. 872-884. Oxford University Press 10.1002/ejhf.2842

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AIMS

The impact of the cardio-hepatic syndrome (CHS) on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for relevant mitral regurgitation (MR) is unknown. The objectives of this study were three-fold: (I) to characterize the pattern of hepatic impairment, (II) to investigate the prognostic value of CHS, and (III) to evaluate the changes in hepatic function after M-TEER.

METHODS AND RESULTS

Hepatic impairment was quantified by laboratory parameters of liver function. In accordance with existing literature, two types of CHS were distinguished: Ischemic type I CHS (elevation of both transaminases) and cholestatic type II CHS (elevation of two out of three parameters of hepatic cholestasis). The impact of CHS on two-year mortality was evaluated using a Cox model. The change in hepatic function after M-TEER was assessed by laboratory testing at follow-up. We analyzed 1083 patients who underwent M-TEER for relevant primary or secondary MR at four European centers between 2008 and 2019. Ischemic type I and cholestatic type II CHS were observed in 11.1% and 23.0% of patients, respectively. Predictors for two-year all-cause mortality differed by MR etiology. While in primary MR cholestatic type II CHS was independently associated with two-year mortality, ischemic CHS type I was an independent mortality predictor in SMR patients. At follow-up, patients with MR reduction ≤2+ (obtained in 90.7% of patients) presented with improved parameters of hepatic function (median reduction of 0.2mg/dl, 0.2U/l and 21U/l for bilirubin, ALT and GGT, respectively, p<0.01).

CONCLUSIONS

CHS is frequently observed in patients undergoing M-TEER and significantly impairs two-year survival. Successful M-TEER may have beneficial effects on CHS.

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