1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Krankenhaus Barmherzige Brüder Regensburg Klinik für Kardiologie Regensburg, Deutschland; 3Klinikum St. Marien Klinik für Innere Medizin I Amberg, Deutschland; 4Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland
Background:
In patients with severe mitral regurgitation (MR) and high surgical risk transcatheter edge-to-edge mitral valve repair (M-TEER) emerged as a reasonable treatment option. Especially in secondary MR with reduced left ventricular ejection fraction (LVEF) data on predictors for outcome after M-TEER are missing. The aim of this study was to investigate the impact of stroke volume (SV) on outcome regarding death and hospitalization for heart failure (HF).
Methods:
We enrolled 68 patients (age 74±10 years, 33.8% female) undergoing M-TEER for severe secondary MR (MR grade III 17.6%, MR grade IV 82.4%) with reduced LVEF (36±13%) in a prospective single-center study (Table 1). At baseline and one month after M-TEER LVEF, SV (LVOT), MR grade, left ventricular enddiastolic diameter (LVEDD), left ventricular endsystolic diameter (LVESD), left atrial volume index (LAVI), tricuspid regurgitation (TR) grade and right ventricular function (TAPSE) were assessed by transthoracic echocardiography (TTE). Death and hospitalization for HF were observed until one year following M-TEER.
Results:
A successful reduction of MR grade was achieved in 95.6% (postprocedural MR grade I 66.2%, MR grade II 29.4%, Table 2), accompanied by a significant reduction of LAVI (83±33 ml/m2 vs. 70±25 ml/m2, p<0.001). No improvement of SV at 1 month follow up could be detected (SV baseline 53±21 ml vs. SV 1 month 52±19 ml, p=0.910). Additionally, Cardiac output, LVEDD, LVESD showed no improvement (Table 2). LVEF slightly increased (36±13% vs. 37±12%, p=0.022). TR grade decreased significantly (p=0.003) and TAPSE improved (17±4 mm vs. 19±4 mm, p=0.001). Change in SV (SV), LVEF and NYHA class at baseline were no predictors for death (Table 3) and HF hospitalization at one year (Table 4). Merely, LVEF at baseline seems to predict death (OR 0.94 (95% CI 0.89-0.99), p=0.024) but not HF hospitalization.
Conclusion:
In our study cohort, no improvement of SV could be observed within one month after successful M-TEER in patients with secondary MR. Additionally, SV did not predict outcome regarding death and HF hospitalization at one year follow-up. LVEF at baseline may be a predictor for death, but not for HF hospitalization.
Table 1 Baseline Characteristics (n=68)
|
Age, years |
74±10 |
|
Female gender |
23 (33.8) |
|
BMI, kg/m² |
26.4±4.6 |
|
MR of secondary/mixed etiology |
68 (100.0) |
|
Coronary artery disease |
47 (69.1) |
|
Atrial fibrillation |
41 (60.3) |
|
Diabetes mellitus |
23 (33.8) |
|
EuroSCORE II, % |
6.0 [4.0-9.9] |
|
GFR, ml/min |
48±23 |
|
NTproBNP, pg/ml |
3259 [1710-6837] |
|
NYHA class |
|
|
I |
0 |
|
II |
11 (16.4) |
|
III |
52 (77.6) |
|
IV |
4 (6.0) |
|
Six-minute walk distance, m |
248±103 |
Table 2 Echocardiographic Outcomes
|
|
baseline |
1 month |
p-value |
|
Stroke volume (LVOT), ml |
53±21 |
52±19 |
0.910 |
|
Cardiac output (LVOT), l/min |
3.56±1.25 |
3.59±1.40 |
0.899 |
|
MR grade |
|
|
<0.001 |
|
I |
0 |
45 (66.2) | |
|
II |
0 |
20 (29.4) | |
|
III |
12 (17.6) |
2 (2.9) | |
|
IV |
56 (82.4) |
1 (1.5) | |
|
LVEF, % |
36±13 |
37±12 |
0.022 |
|
LVEDD, mm |
63±9 |
62±9 |
0.173 |
|
LVESD, mm |
54±11 |
54±10 |
0.562 |
|
LAVI, ml/m² |
83±33 |
70±25 |
<0.001 |
|
TR grade |
|
|
0.003 |
|
Mild |
21 (31.8) |
30 (44.8) | |
|
Moderate |
20 (30.3) |
21 (31.3) | |
|
Severe |
25 (37.9) |
16 (23.9) | |
|
sPAP, mmHg |
41±14 |
38±13 |
0.064 |
|
TAPSE, mm |
17±4 |
19±4 |
0.001 |
Table 3 Predictors on outcome
|
|
Death |
HF hospitalization | ||
|
Variable |
OR (95%CI) |
p-value |
OR (95%CI) |
p-value |
|
∆SV at 1 month, ml |
1.00 (0.97-1.03) |
0.960 |
1.00 (0.98-1.02) |
0.896 |
|
Age, years |
0.96 (0.90-1.03) |
0.232 |
0.97 (0.93-1.01) |
0.156 |
|
LVEF baseline, % |
0.94 (0.89-0.99) |
0.024 |
1.00 (0.97-1.03) |
0.989 |
|
NYHA class baseline |
0.53 (0.11-2.51) |
0.424 |
1.54 (0.55-4.31) |
0.413 |