Universität zu Köln

Orban, Mathias, Karam, Nicole ORCID: 0000-0002-3861-6914, Lubos, Edith, Kalbacher, Daniel, Braun, Daniel, Deseive, Simon, Neuss, Michael, Butter, Christian, Praz, Fabien ORCID: 0000-0001-5416-165X, Kassar, Mohammad, Petrescu, Aniela, Pfister, Roman, Iliadis, Christos, Unterhuber, Matthias ORCID: 0000-0002-8175-276X, Lurz, Philipp, Thiele, Holger, Baldus, Stephan, von Bardeleben, Ralph Stephan ORCID: 0000-0002-1356-0037, Blankenberg, Stefan, Massberg, Steffen, Windecker, Stephan and Hausleiter, Joerg (2021). Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair. JACC-Cardiovasc. Imag., 14 (4). S. 715 - 726. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7591

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Abstract

OBJECTIVES The purpose of this paper was to evaluate the impact of proportionality of secondary mitral regurgitation (SMR) in a large real-world registry of transcatheter edge-to-edge mitral valve repair (TMVr) BACKGROUND Differences in the outcomes of recent randomized trials of TMVr for SMR may be explained by the proportionality of SMR severity to left ventricular (LV) volume. METHODS The ratio of pre-procedural effective regurgitant orifice area (EROA) to LV end-diastolic volume (LVEDV) was retrospectively assessed in patients undergoing TMVr for severe SMR between 2008 and 2019 from the EuroSMR registry. A recently proposed SMR proportionality scheme was adapted to stratify patients according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD), MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was assessed as a primary outcome, secondary heart failure (HF) outcomes included hospitalization for HF (HHF), New York Heart Association (NYHA) functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP), 6-min-walk distance, quality of life and MR grade. RESULTS A total of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months after TMVr. MR was reduced to grade <= 2+ in 92%, 96%, and 94% of patients (for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for covariates including age, sex, diabetes, kidney function, body surface area, LV ejection fraction, and procedural MR reduction (grade <= 2+), adjusted rates of 2-year mortality in MD patients did not differ from those for MLCD patients (17% vs. 18%, respectively), whereas it was higher in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD; p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD, 82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class was seen in all groups (p < 0.001). Values for 6-min-walk distances, quality of life and NT-proBNP improved in most patients. CONCLUSIONS MD and MLCD patients had a comparable, adjusted 2-year mortality rate after TMVr which was slightly better than that of LD patients. Patients treated with TMVr had symptomatic improvement regardless of EROA/LVEDV ratio. (C) 2021 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Orban, Mathias UNSPECIFIED UNSPECIFIED UNSPECIFIED Karam, Nicole UNSPECIFIED orcid.org/0000-0002-3861-6914 UNSPECIFIED Lubos, Edith UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalbacher, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Braun, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Deseive, Simon UNSPECIFIED UNSPECIFIED UNSPECIFIED Neuss, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Butter, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Praz, Fabien UNSPECIFIED orcid.org/0000-0001-5416-165X UNSPECIFIED Kassar, Mohammad UNSPECIFIED UNSPECIFIED UNSPECIFIED Petrescu, Aniela UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Iliadis, Christos UNSPECIFIED UNSPECIFIED UNSPECIFIED Unterhuber, Matthias UNSPECIFIED orcid.org/0000-0002-8175-276X UNSPECIFIED Lurz, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Thiele, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED von Bardeleben, Ralph Stephan UNSPECIFIED orcid.org/0000-0002-1356-0037 UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Massberg, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Windecker, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Hausleiter, Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-599788
DOI:	10.1016/j.jcmg.2020.05.042
Journal or Publication Title:	JACC-Cardiovasc. Imag.
Volume:	14
Number:	4
Page Range:	S. 715 - 726
Date:	2021
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1876-7591
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59978