A1 Refereed original research article in a scientific journal
Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
Authors: 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, Kassar Mohammad, Weckbach Ludwig T., Butter Christian, Stocker Thomas J., Neuss Michael, Melica Bruno, Braun Daniel, Windecker Stephan, Massberg Steffen, Praz Fabien, Näbauer Michael, Kalbacher Daniel, Lurz Philipp, Metra Marcp, Bax Jeroen J., Hausleiter Jörg
Publisher: Elsevier Inc.
Publication year: 2023
Journal: JACC: Cardiovascular Interventions
Journal name in source: JACC: Cardiovascular Interventions
Volume: 16
Issue: 2
First page : 140
Last page: 151
eISSN: 1876-7605
DOI: https://doi.org/10.1016/j.jcin.2022.10.032
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 ¼ 81) presented with left ventricular involvement, 46% (n ¼ 393) with left atrial involvement, 15% (n ¼ 129) with right ventricular pressure/volume overload, and 29% (n ¼ 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.
