Iliadis, Christos, Baldus, Stephan, Kalbacher, Daniel, Boekstegers, Peter, Schillinger, Wolfgang, Ouarrak, Taoufik, Zahn, Ralf, Butter, Christian, Zuern, Christine S., von Bardeleben, Ralph Stephan, Senges, Jochen, Bekeredjian, Raffi, Eggebrecht, Holger and Pfister, Roman (2020). Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry. Eur. J. Heart Fail., 22 (7). S. 1202 - 1211. HOBOKEN: WILEY. ISSN 1879-0844

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Abstract

Background Left atrial (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair, LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation. Methods and results Data from the multicentre German TRAnscatheter Mitral valve Interventions registry (TRAMI) were used to analyse the association of baseline LA diameter by tertiles with efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with MitraClip. In 520 of 843 patients prospectively enrolled in TRAMI, baseline LA diameter were reported [median (interquartile range) LA diameter in tertiles: 44 (40-46) mm, 51 (48-53) mm and 60 (55-66) mm]. Larger LA diameters were significantly associated with secondary aetiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all P < 0.05). Technical success was not different across tertiles (96%, 95.4% and 98.4%, respectively; P = 0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke: 1.8%, 1.2% and 4.4%, respectively; P = 0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7%, respectively; P < 0.01), as did hospitalization in survivors (60%, 67.6% and 78.9%, respectively; P < 0.05). The association between LA diameter and outcome remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter. Conclusion Left atrial enlargement is a strong and independent predictor of adverse long-term outcome after transcatheter mitral valve repair. Further study is warranted to examine whether timely intervention may have the potential to modify outcome.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Iliadis, ChristosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalbacher, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boekstegers, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schillinger, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ouarrak, TaoufikUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zahn, RalfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butter, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zuern, Christine S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Bardeleben, Ralph StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Senges, JochenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bekeredjian, RaffiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eggebrecht, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfister, RomanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-337593
DOI: 10.1002/ejhf.1820
Journal or Publication Title: Eur. J. Heart Fail.
Volume: 22
Number: 7
Page Range: S. 1202 - 1211
Date: 2020
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1879-0844
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
VALVULAR HEART-DISEASE; EUROPEAN ASSOCIATION; GUIDELINES; MANAGEMENT; SURGERY; THERAPY; FAILURE; SOCIETY; SIZEMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/33759

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