Role of left ventricular cardiac power index to predict mortality after transcatheter edge-to-edge-repair for severe mitral valve regurgitation

Azza Ben Ammar (Bremen)1, U. Hanses (Bremen)1, K. Diehl (Bremen)2, S. Alo (Bremen)2, J. Schmucker (Bremen)3, P. Dierks (Bremen)1, C. Frerker (Lübeck)4, I. Eitel (Lübeck)4, H. Wienbergen (Lübeck)5, R. Hambrecht (Bremen)6, R. Osteresch (Bremen)2

1Klinikum Links der Weser Klinik für Innere Medizin II Bremen, Deutschland; 2Klinikum Links der Weser Klinik für Kardiologie und Angiologie Bremen, Deutschland; 3Klinikum Bremen-Mitte Klinik für Innere Medizin III Bremen, Deutschland; 4Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 5Universitätsklinikum Schleswig-Holstein Lübeck, Deutschland; 6Klinikum Links der Weser Innere Medizin I Bremen, Deutschland


Background: Left ventricular cardiac power index (CPI) is a known predictor of worse clinical outcome in various domains of heart failure. However, the prognostic utility of CPI in transcatheter edge-to-edge-repair (TEER) for severe mitral regurgitation (MR) has never been tested.

Objective: To assess the impact of CPI on mortality in patients with severe MR undergoing TEER.

Method: Consecutive patients with severe MR who underwent TEER were included and followed prospectively. Primary endpoint was defined as all-cause mortality
during a median follow-up period of 14 months (8 - 22). CPI was calculated as: [Cardiac index * mean arterial pressure] / 451 = W/m². Receiver operator
characteristic (ROC) analysis was used to determine discriminative capacity of CPI. Kaplan-Meier estimate was used for survival analysis. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for all-cause mortality.

Results: 615 patients (mean age, 79 ± 7 years, 54% male) at high operative risk (LogEuro-SCORE 17 %, 11 % - 25 %) were enrolled. Mean CPI was 0.42 ± 0.14
W/m². At long-term follow-up, 161 patients died (31%). ROC curve analysis demonstrated that CPI was associated with an area under the curve of 0.60
(95 % confidence interval (CI) 0.54 - 0.65; p = 0.01). CPI threshold of 0.40 W/m² was associated with 65% sensitivity and 54% specificity for long-term mortality. All-cause mortality was significantly higher in the CPI ≤ 0.40 W/m² group compared to those with a CPI > 0.40 W/m² (38 % vs. 23 %; p < 0.001).
In Cox regression analysis CPI was an independent predictor for all-cause mortality (hazard ratio 0.85; 95% CI 0.74 - 0.98; p = 0.025).
Conclusions: CPI is associated with mortality among patients undergoing TEER for severe MR. Therefore, CPI might be useful in risk stratification of TEER candidates.
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