1Bremer Institut für Herz- und Kreislaufforschung (BIHKF) Bremen, Deutschland; 2Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Center for Cardiovascular Research (DZHK), Partner site Hamburg - Kiel - Lübeck, Germany Lübeck, Deutschland
Background: Postcapillary pulmonary hypertension (pc-PH) is associated with increased mortality in patients with severe mitral regurgitation (MR). However, the influence of isolated pc-PH (IpcPH) and combined post- and precapillary pulmonary hypertension (CpcPH) on outcome is unclear.
Objective: To assess outcome of different types of pc-PH in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) for severe MR.
Methods: Consecutive patients with severe MR and pc-PH (mean pulmonary artery pressure > 20 mmHg and pulmonary artery wedge pressure > 15 mmHg) who underwent M-TEER were included and followed prospectively. Patients were classified as having IpcPH (pulmonary vascular resistance (PVR) < 2 Wood units), CpcPH (PVR ≥ 2 Wood units) and CpcPH with severe precapillary component (PVR > 5 Wood units). Primary outcome was all-cause mortality during a median follow-up period of 16 ± 11 months.
Results: 508 patients were enrolled (median age 79 ± 7.4 years, 51.5 % female). 157 patients (30.9 %) had IpcPH, 246 patients (48.4 %) had CpcPH and 105 patients (20.7 %) had CpcPH with a severe precapillary component. At long-term follow-up, a significantly lower survival rate was observed in patients with CpcPH with a severe precapillary component (66.6 % vs. 75.0 % vs. 76.8 %; log-rank p = 0.026). In Cox regression analysis failed M-TEER procedures (hazard ratio (HR) 6.6; 95 % confidence interval (CI) 2.0 to 21.8; p = 0.002) and the invasively derived pulmonary artery pulsatility index (PAPi; HR 0.78; 95 % CI 0.64 to 0.93; p = 0.015) were the strongest predictors for all-cause mortality in this cohort of patients.
Conclusions: In patients undergoing M-TEER CpcPH with a severe precapillary component is common and is associated with worse outcome. Therefore, classification of pc-PH by right heart catheterization could improve the risk assessment of patients undergoing M-TEER.