Left atrial volume index and outcome after transcatheter edge-to-edge valve repair for secondary mitral regurgitation
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Left atrial volume index and outcome after transcatheter edge-to-edge valve repair for secondary mitral regurgitation. / Iliadis, Christos; Kalbacher, Daniel; Lurz, Philipp; Petrescu, Aniela; Orban, Mathias; Puscas, Tania; Lupi, Laura; Stazzoni, Laura; Pires-Morais, Gustavo; Köll, Benedikt; Besler, Christian; Ruf, Tobias; Stolz, Lukas; Tence, Noemie; Adamo, Marianna; Giannini, Cristina; Guerreiro, Cláudio; hellmich, Martin; Baldus, Stephan; Schofer, Niklas; Thiele, Holger; Stephan von Bardeleben, Ralph; Hausleiter, Jörg; Karam, Nicole; Metra, Marco; Petronio, Anna Sonia; Melica, Bruno; Pfister, Roman.
In: EUR J HEART FAIL, Vol. 24, No. 7, 24.07.2022, p. 1282-1292.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Left atrial volume index and outcome after transcatheter edge-to-edge valve repair for secondary mitral regurgitation
AU - Iliadis, Christos
AU - Kalbacher, Daniel
AU - Lurz, Philipp
AU - Petrescu, Aniela
AU - Orban, Mathias
AU - Puscas, Tania
AU - Lupi, Laura
AU - Stazzoni, Laura
AU - Pires-Morais, Gustavo
AU - Köll, Benedikt
AU - Besler, Christian
AU - Ruf, Tobias
AU - Stolz, Lukas
AU - Tence, Noemie
AU - Adamo, Marianna
AU - Giannini, Cristina
AU - Guerreiro, Cláudio
AU - hellmich, Martin
AU - Baldus, Stephan
AU - Schofer, Niklas
AU - Thiele, Holger
AU - Stephan von Bardeleben, Ralph
AU - Hausleiter, Jörg
AU - Karam, Nicole
AU - Metra, Marco
AU - Petronio, Anna Sonia
AU - Melica, Bruno
AU - Pfister, Roman
PY - 2022/7/24
Y1 - 2022/7/24
N2 - AimsTo investigate the role of left atrial volume index (LAVi) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER).Methods and resultsOutcomes were evaluated in SMR patients of a European multicentre registry according to baseline LAVi. Main analysis was performed for all-cause mortality; residual mitral regurgitation (MR) and New York Heart Association (NYHA) class improvement were analysed for patients available. A total of 1074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46–73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%–96% (p = 0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%–68% of patients) (p = 0.66). The risk of mortality increased by 23%–42% in the four upper quintiles compared to the bottom quintile (LAVi <42 ml/m2). The hazard ratio (HR) of mortality was 1.35 (95% confidence interval [CI] 1.02–1.78, p = 0.035) associated with a LAVi >42 ml/m2, which was attenuated after multivariable adjustment (HR 1.18, 95% CI 0.83–1.67, p = 0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitant orifice area (HR 1.99, 95% CI 1.06–3.74, p = 0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95% CI 1.02–2.75, p = 0.042) in multivariable analysis.ConclusionProcedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of left atrial enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long-term outcome after TEER.
AB - AimsTo investigate the role of left atrial volume index (LAVi) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER).Methods and resultsOutcomes were evaluated in SMR patients of a European multicentre registry according to baseline LAVi. Main analysis was performed for all-cause mortality; residual mitral regurgitation (MR) and New York Heart Association (NYHA) class improvement were analysed for patients available. A total of 1074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46–73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%–96% (p = 0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%–68% of patients) (p = 0.66). The risk of mortality increased by 23%–42% in the four upper quintiles compared to the bottom quintile (LAVi <42 ml/m2). The hazard ratio (HR) of mortality was 1.35 (95% confidence interval [CI] 1.02–1.78, p = 0.035) associated with a LAVi >42 ml/m2, which was attenuated after multivariable adjustment (HR 1.18, 95% CI 0.83–1.67, p = 0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitant orifice area (HR 1.99, 95% CI 1.06–3.74, p = 0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95% CI 1.02–2.75, p = 0.042) in multivariable analysis.ConclusionProcedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of left atrial enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long-term outcome after TEER.
U2 - 10.1002/ejhf.2565
DO - 10.1002/ejhf.2565
M3 - SCORING: Journal article
VL - 24
SP - 1282
EP - 1292
JO - EUR J HEART FAIL
JF - EUR J HEART FAIL
SN - 1388-9842
IS - 7
ER -
