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Early symptomatic benefit indicates long-term prognosis after transcatheter mitral valve edge-to-edge repair in functional and degenerative etiology

Background - Mitral regurgitation (MR) is common in patients with heart failure and constitutes an independent risk factor for adverse prognosis besides NYHA-class. The predictive value of dyspnea reduction after transcatheter mitral valve repair (TMVr) on outcome has not been investigated up to now...

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Main Authors: Geyer, Martin (Author) , Keller, Karsten (Author) , Tamm, Alexander R. (Author) , Börnert, Sonja Karin Claudia (Author) , Bachmann, Kevin (Author) , Ruf, Tobias Friedrich (Author) , Kreidel, Felix (Author) , Hahad, Omar (Author) , Petrescu, Aniela (Author) , Schnitzler, Katharina (Author) , Schmitt, Volker H. (Author) , Da Rocha e Silva, Jaqueline Grace (Author) , Hell, Michaela M. (Author) , Schulz, Eberhard (Author) , Münzel, Thomas (Author) , Bardeleben, Ralph Stephan von (Author)
Format: Article (Journal)
Language:English
Published: 23 September 2021
In: International journal of cardiology
Year: 2021, Volume: 344, Pages: 141-146
ISSN:1874-1754
DOI:10.1016/j.ijcard.2021.09.038
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ijcard.2021.09.038
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0167527321014790
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Author Notes:Martin Geyer, Karsten Keller, Alexander R. Tamm, Sonja Born, Kevin Bachmann, Tobias Friedrich Ruf, Felix Kreidel, Omar Hahad, Aniela Petrescu, Katharina Schnitzler, Volker H. Schmitt, Jaqueline Grace da Rocha e Silva, Michaela M. Hell, Eberhard Schulz, Thomas Münzel, Ralph Stephan von Bardeleben
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Summary:Background - Mitral regurgitation (MR) is common in patients with heart failure and constitutes an independent risk factor for adverse prognosis besides NYHA-class. The predictive value of dyspnea reduction after transcatheter mitral valve repair (TMVr) on outcome has not been investigated up to now. - Methods and results - We enrolled 627 consecutive patients (47.0% female, 57.4% functional MR; median follow-up 486 days[IQR 157/961]; survival status available in 96.8%; symptoms assessed in n = 556 at baseline / n = 406 at 1 month) treated with isolated percutaneous mitral valve edge-to-edge repair in our center from 06/2010-03/2018 (exclusion of combined forms of TMVr) in a monocentric retrospective analysis. Survival was 97.6% at discharge, 73.9% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7-years. Before TMVr, NYHA-classes III/IV were found in 89.0%. Of these, 74.7% reported symptomatic relief (reduction in NYHA-class) one month after procedure (NYHA class recorded in 406 patients at 30 days). NYHA-classes III/IV were documented in 37.2% (p < 0.001) at 30 days and in 36.6% (p < 0.001) at 1 year without significant changes between the follow-ups. Dyspnea reduction was accompanied by significantly improved long-term survival (1 year, 89.1 vs 71.2%, p = 0.001, 2 years: 75.5 vs 58.7%, p = 0.039) and was identified as an independent predictor for lower mortality (1-year HR for increased mortality by missing symptomatic improvement 2.94 [95%CI 1.53-5.65], p = 0.001; long-term HR 1.95 [95%CI 1.29-2.94], p = 0.001) independently in both etiologies of MR. - Conclusion - TMVr by edge-to-edge therapy enables early and sustainable symptomatic improvement in nearly 75% of the symptomatic patients. The simple assessment of postinterventional changes in NYHA-class might serve as an independent predictor for mid- and long-term prognosis in both FMR and DMR.
Item Description:Gesehen am 06.04.2022
Physical Description:Online Resource
ISSN:1874-1754
DOI:10.1016/j.ijcard.2021.09.038

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