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.