Universität zu Köln

Mauri, Victor, Koerber, Maria, I, Kuhn, Elmar, Schmidt, Tobias, Frerker, Christian, Wahlers, Thorsten, Rudolph, Tanja K., Baldus, Stephan, Adam, Matti ORCID: 0000-0002-6990-8135 and ten Freyhaus, Henrik (2020). Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Clin. Res. Cardiol., 109 (10). S. 1261 - 1271. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Objective The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR). Background Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. Methods Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement. Results 15.2% of patients presented with baseline MR >= 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR <= 2 +. MR improvement to <= 2 + was associated with significantly better survival compared to patients with persistent MR >= 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (>= 32 mm) predicted the likelihood of an improvement to MR <= 2 +. A score based on these parameters selected groups with differing probability of MR <= 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality. Conclusion Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Graphic abstract Factors associated with MR persistence or regression after TAVR [GRAPHICS] .

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Koerber, Maria, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Frerker, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED orcid.org/0000-0002-6990-8135 UNSPECIFIED ten Freyhaus, Henrik UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-344598
DOI:	10.1007/s00392-020-01618-9
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	109
Number:	10
Page Range:	S. 1261 - 1271
Date:	2020
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language VALVULAR HEART-DISEASE; ANNULAR CALCIFICATION; EUROPEAN ASSOCIATION; RISK PATIENTS; TASK-FORCE; IMPACT; IMPLANTATION; STENOSIS; OUTCOMES; RECOMMENDATIONS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34459