Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair.
J Am Heart Assoc
; 13(5): e032784, 2024 Mar 05.
Article
en En
| MEDLINE
| ID: mdl-38390821
ABSTRACT
BACKGROUND:
Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER. METHODS ANDRESULTS:
We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022. Using well-established outcomes-related cutoffs for predischarge MR (≥moderate), TR (≥moderate), and TMPG (≥5 mm Hg), 3 echo profiles were developed based on the number of risk factors present (optimal 0 risk factors, mixed 1 risk factor, poor ≥2 risk factors). Discrimination of the profiles for predicting the primary composite end point of all-cause mortality and heart failure hospitalization at 2 years was examined using Cox regression. Overall, mean age was 76.7±10.6 years, 43.3% were women, and 53% had primary MR. Two-year event-free survival was 61%. Predischarge TR≥moderate, MR≥moderate, and TMPG≥5 mm Hg were risk factors associated with the primary end point. Compared with the optimal profile, there was an incremental risk in 2-year event-rate with each worsening profile (optimal as reference; mixed profile hazard ratio (HR), 2.87 [95% CI, 1.71-5.17], P<0.001; poor profile HR, 3.76 [95% CI, 1.84-6.53], P<0.001). Echocardiographic profile was statistically associated with the 2-year mortality end point (optimal as reference; mixed profile HR, 3.55 [95% CI, 1.81-5.96], P<0.001; poor profile HR, 3.39 [95% CI, 2.56-7.33], P=0.02).CONCLUSIONS:
The echocardiographic profile integrating predischarge TR, MR, and TMPG presents a novel prognostic stratification tool for patients undergoing mitral TEER.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Insuficiencia de la Válvula Tricúspide
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Implantación de Prótesis de Válvulas Cardíacas
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Insuficiencia Cardíaca
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Mercurio
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Insuficiencia de la Válvula Mitral
Límite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Año:
2024
Tipo del documento:
Article