Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair
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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; Windecker, Stephan; Hausleiter, Jörg; EuroSMR Investigators.
in: JACC-CARDIOVASC IMAG, Jahrgang 14, Nr. 4, 04.2021, S. 715-725.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair
AU - Orban, Mathias
AU - Karam, Nicole
AU - Lubos, Edith
AU - Kalbacher, Daniel
AU - Braun, Daniel
AU - Deseive, Simon
AU - Neuss, Michael
AU - Butter, Christian
AU - Praz, Fabien
AU - Kassar, Mohammad
AU - Petrescu, Aniela
AU - Pfister, Roman
AU - Iliadis, Christos
AU - Unterhuber, Matthias
AU - Lurz, Philipp
AU - Thiele, Holger
AU - Baldus, Stephan
AU - Stephan von Bardeleben, Ralph
AU - Blankenberg, Stefan
AU - Massberg, Steffen
AU - Windecker, Stephan
AU - Hausleiter, Jörg
AU - EuroSMR Investigators
N1 - Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - 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.
AB - 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.
KW - Humans
KW - Mitral Valve/diagnostic imaging
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Predictive Value of Tests
KW - Quality of Life
KW - Retrospective Studies
KW - Treatment Outcome
U2 - 10.1016/j.jcmg.2020.05.042
DO - 10.1016/j.jcmg.2020.05.042
M3 - SCORING: Journal article
C2 - 32861652
VL - 14
SP - 715
EP - 725
JO - JACC-CARDIOVASC IMAG
JF - JACC-CARDIOVASC IMAG
SN - 1936-878X
IS - 4
ER -