Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
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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; Kassar, Mohammad; Weckbach, Ludwig T; Butter, Christian; Stocker, Thomas J; Neuss, Michael; Melica, Bruno; Braun, Daniel; Windecker, Stephan; Massberg, Steffen; Praz, Fabien; Näbauer, Micheal; Kalbacher, Daniel; Lurz, Philipp; Metra, Marco; Bax, Jeroen J; Hausleiter, Jörg; EuroSMR Investigators.
in: JACC-CARDIOVASC INTE, Jahrgang 16, Nr. 2, 23.01.2023, S. 140-151.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair
AU - Stolz, Lukas
AU - Doldi, Philipp M
AU - Orban, Mathias
AU - Karam, Nicole
AU - Puscas, Tania
AU - Wild, Mirjam G
AU - Popescu, Aniela
AU - von Bardeleben, Ralph Stephan
AU - Iliadis, Christos
AU - Baldus, Stephan
AU - Adamo, Marianna
AU - Thiele, Holger
AU - Besler, Christian
AU - Unterhuber, Matthias
AU - Ruf, Tobias
AU - Pfister, Roman
AU - Higuchi, Satoshi
AU - Koell, Benedikt
AU - Giannini, Christina
AU - Petronio, Anna
AU - Kassar, Mohammad
AU - Weckbach, Ludwig T
AU - Butter, Christian
AU - Stocker, Thomas J
AU - Neuss, Michael
AU - Melica, Bruno
AU - Braun, Daniel
AU - Windecker, Stephan
AU - Massberg, Steffen
AU - Praz, Fabien
AU - Näbauer, Micheal
AU - Kalbacher, Daniel
AU - Lurz, Philipp
AU - Metra, Marco
AU - Bax, Jeroen J
AU - Hausleiter, Jörg
AU - EuroSMR Investigators
N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/1/23
Y1 - 2023/1/23
N2 - 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.
AB - 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.
KW - Humans
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Heart Failure/diagnostic imaging
KW - Mitral Valve/diagnostic imaging
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Atrial Fibrillation
KW - Treatment Outcome
KW - Stroke Volume
U2 - 10.1016/j.jcin.2022.10.032
DO - 10.1016/j.jcin.2022.10.032
M3 - SCORING: Journal article
C2 - 36697148
VL - 16
SP - 140
EP - 151
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 2
ER -