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

被引:4
作者
Geyer, Martin [1 ]
Keller, Karsten [1 ,2 ,3 ]
Tamm, Alexander R. [1 ]
Born, Sonja [1 ]
Bachmann, Kevin [1 ]
Ruf, Tobias Friedrich [1 ]
Kreidel, Felix [1 ]
Hahad, Omar [1 ,4 ]
Petrescu, Aniela [1 ]
Schnitzler, Katharina [1 ]
Schmitt, Volker H. [1 ]
Silva, Jaqueline Grace da Rocha E. [1 ]
Hell, Michaela M. [1 ]
Schulz, Eberhard [1 ]
Muenzel, Thomas [1 ,4 ]
von Bardeleben, Ralph Stephan [1 ]
机构
[1] Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Dept Cardiol, Cardiol 1, Mainz, Germany
[2] Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Ctr Thrombosis & Hemostasis CTH, Mainz, Germany
[3] Univ Hosp Heidelberg, Dept Sports Med, Med Clin 7, Heidelberg, Germany
[4] German Ctr Cardiovasc Res DZHK, Partner Site Rhine Main, Mainz, Germany
关键词
Mitral regurgitation; Heart failure; Mitral valve repair; MitraClip; NYHA-class; Survival; NATIVE VALVULAR REGURGITATION; EUROPEAN ASSOCIATION; AMERICAN SOCIETY; HEART-FAILURE; OUTCOMES; RECOMMENDATIONS; ECHOCARDIOGRAPHY; PREDICTORS;
D O I
10.1016/j.ijcard.2021.09.038
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:141 / 146
页数:6
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