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de Sá Marchi MF, van den Dorpel M, Calomeni P, Chatterjee S, Adrichem R, Verhemel S, Van Den Enden AJM, Daemen J, Kardys I, Ribeiro HB, Van Mieghem NM. Comparative analysis of different risk prediction tools after mitral Transcatheter edge-to-edge repair. Int J Cardiol 2024; 400:131768. [PMID: 38211668 DOI: 10.1016/j.ijcard.2024.131768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/26/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Transcatheter edge-to-edge repair (TEER) has become an established treatment for primary and secondary mitral regurgitation (PMR and SMR). The objective of this study was to compare the accuracy of different risk scores for predicting 1-year mortality and the composite endpoint of 1-year mortality and/or heart failure (HF) hospitalization after TEER. METHODS We analyzed data from 206 patients treated for MR at a tertiary European center between 2011 and 2023 and compared the accuracy of different mitral and surgical risk scores: EuroSCORE II, GRASP, MITRALITY, MitraScore, TAPSE/PASP-MitraScore, and STS for predicting 1-year mortality and the composite of 1-year mortality and/or HF hospitalization in PMR and SMR. A subanalysis of SMR-only patients with the addition of COAPT Risk Score and baseline N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) list was also performed. RESULTS MITRALITY had the best discriminative ability for 1-year mortality and the composite endpoint of 1-year mortality and/or HF hospitalization, with an area under the curve (AUC) of 0.74 and 0.74, respectively, in a composed group of PMR and SMR. In a SMR-only population, MITRALITY also presented the best AUC for 1-year mortality and the composite endpoint of 1-year mortality and/or HF hospitalization, with values of 0.72 and 0.72, respectively. CONCLUSION MITRALITY was the best mitral TEER risk model for both 1-year mortality and the composite endpoint of 1-year mortality and/or HF hospitalization in a population of PMR and SMR patients, as well as in SMR patients only. Surgical risk scores, MitraScore, TAPSE/PASP-MitraScore and NT-proBNP alone showed poor predictive values.
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Affiliation(s)
- Mauricio Felippi de Sá Marchi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Interventional Cardiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Mark van den Dorpel
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pedro Calomeni
- Department of Interventional Cardiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Sraman Chatterjee
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sarah Verhemel
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antoon J M Van Den Enden
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henrique Barbosa Ribeiro
- Department of Interventional Cardiology, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Hatab T, Bou Chaaya RG, Zaid S, Wessly P, Satish P, Villanueva V, Faza N, Little SH, Atkins MD, Reardon MJ, Kleiman NS, Zoghbi WA, Goel SS. Feasibility and Outcomes of Mitral Transcatheter Edge-To-Edge Repair in Patients With Variable Degrees of Mitral Annular Calcification. J Am Heart Assoc 2023; 12:e031118. [PMID: 37753800 PMCID: PMC10727232 DOI: 10.1161/jaha.123.031118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/23/2023] [Indexed: 09/28/2023]
Abstract
Background The clinical significance of mitral annular calcification (MAC) in patients undergoing mitral transcatheter edge-to-edge repair is not well understood. There is limited evidence regarding the feasibility, durability of repair, and the prognostic value of MAC in this population. We sought to examine the prognostic value of MAC, its severity, and its impact on procedural success and durability of mitral transcatheter edge-to-edge repair. Methods and Results We reviewed the records of 280 patients with moderate-severe or severe mitral regurgitation who underwent mitral transcatheter edge-to-edge repair with MitraClip from March 2014 to March 2022. The primary end point was cumulative survival at 1 year. Independent factors associated with the primary end point were identified using multivariable Cox regression. Among 280 patients included in the final analysis, 249 had none/mild MAC, and 31 had moderate/severe MAC. Median follow-up was 23.1 months (interquartile range: 11.1-40.4). Procedural success was comparable in the MAC and non-MAC groups (92.6% versus 91.4%, P=0.79) with similar rates of residual mitral regurgitation ≤2 at 1 year (86.7% versus 93.2%, P=0.55). Moderate/severe MAC was associated with less improvement in New York Heart Association III/IV at 30 days when compared with none/mild MAC (45.8% versus 14.3%, P=0.001). The moderate/severe MAC group had lower cumulative 1-year survival (56.8% versus 80.0%, hazard ratio [HR], 1.98 [95% CI, 1.27-3.10], P=0.002). Moderate/severe MAC and Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair were independently associated with the primary end point (HR, 2.20 [1.10-4.41], P=0.02; and HR, 1.014 [1.006-1.078], P=0.02, respectively). Conclusions Mitral TEER is a safe and feasible intervention in selected patients with significant MAC and associated with similar mitral regurgitation reduction at 1 year compared with patients with none/mild MAC. Patients with moderate/severe MAC had a high 1-year mortality and less improvement in their symptoms after TEER.
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Affiliation(s)
- Taha Hatab
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Marvin D. Atkins
- Department of Cardiovascular SurgeryHouston Methodist HospitalHoustonTX
| | | | - Neal S. Kleiman
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
| | | | - Sachin S. Goel
- Houston Methodist DeBakey Heart and Vascular CenterHoustonTX
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Paukovitsch M, Felbel D, Groeger M, Rottbauer W, Markovic S, Tadic M, Schneider LM, Keßler M. Diabetes Mellitus in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair-A Decade Experience in 1000+ Patients. J Clin Med 2023; 12:jcm12103502. [PMID: 37240610 DOI: 10.3390/jcm12103502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Diabetes mellitus worsens outcomes in patients suffering from heart disease undergoing cardiac procedures. OBJECTIVES To investigate the impact of diabetes in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). METHODS 1118 patients treated with M-TEER for functional (FMR) and degenerative (DMR) mitral regurgitation (MR) between 2010 and 2021 were analyzed using the combined endpoint of death/rehospitalization for heart failure (HFH). RESULTS Among diabetics (N = 306; 27.4%), comorbidities such as coronary artery disease (75.2% vs. 62.7%; p < 0.001) and progressed (stage III/IV) chronic kidney disease (79.5% vs. 72.6%; p = 0.018) were more frequent. The rate of FMR was higher in diabetics (71.9% vs. 64.5%; p < 0.001). The combined endpoint occurred more frequently in diabetics (40.2% vs. 35.6%; log-rank = 0.035). While no difference was observed in FMR patients (36.8% vs. 37.6%; log-rank p = 0.710), rates of the combined endpoint differed significantly between diabetics and non-diabetics in DMR patients (48.8% vs. 31.9%; log-rank p = 0.001) only. However, diabetes did neither predict the combined endpoint in the overall (OR: 0.97; 95% CI 0.65-1.45; p = 0.890) nor in the DMR cohort (OR: 0.73; 95% CI 0.35-1.51; p = 0.389). Among diabetics treated with M-TEER, troponin (OR: 2.32; 95% CI 1.3-3.7; p = 0.002) and estimated glomerular filtration rate (OR: 0.52; 95% CI 0.3-0.88; p = 0.018) independently predicted the combined endpoint. CONCLUSIONS Diabetes is associated with adverse outcomes after M-TEER, particularly in DMR patients. However, diabetes does not predict the combined endpoint. In diabetics undergoing M-TEER, biochemical markers associated with organ function and damage independently predict the combined endpoint of death and rehospitalization.
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Affiliation(s)
- Michael Paukovitsch
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Dominik Felbel
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Matthias Groeger
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Wolfgang Rottbauer
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Sinisa Markovic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Marijana Tadic
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | | | - Mirjam Keßler
- University Heart Center Ulm, University Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
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Schäfer M, Körber MI, Vimalathasan R, Mauri V, Iliadis C, Metze C, Ten Freyhaus H, Baldus S, Polidori MC, Pfister R. Risk Stratification of Patients Undergoing Percutaneous Repair of Mitral and Tricuspid Valves Using a Multidimensional Geriatric Assessment. Circ Cardiovasc Qual Outcomes 2021; 14:e007624. [PMID: 34325515 DOI: 10.1161/circoutcomes.120.007624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Given their advanced age and high comorbidity, individual risk assessment is crucial in patients undergoing transcatheter mitral and tricuspid valve repair. Therefore, we evaluated the use of a comprehensive geriatric assessment score, the multidimensional prognostic index (MPI), for risk stratification in these patients. METHODS We conducted a prospective, observational single-center study, including 226 patients undergoing percutaneous repair for mitral or tricuspid regurgitation. The MPI was calculated preprocedural and covers 8 domains (activities of daily living, instrumental activities of daily living, mental status, nutrition, risk of pressure ulcers, comorbidity, medication, and marital/cohabitation status). We sought to identify an association of MPI score with procedural outcomes and 6-month mortality. RESULTS A total of 53.1% of patients were stratified as low risk according to MPI (MPI-1 group), 44.2% as medium risk (MPI-2 group), and 2.7% as high risk (MPI-3 group). Procedural efficacy and safety were similar between groups. The estimated survival rate at 6 months was 97±2% in MPI-1 group, 79±4% in MPI-2 group (hazard ratio, 6.90 [95% CI, 2.36-12.2]; P≤0.001) and 50±20% in MPI-3 group (hazard ratio, 20.3 [95% CI, 4.51-91.3]; P<0.001). An increase in 1 SD of the MPI score (0.14 points, possible range of MPI score 0-1) was associated with a hazard ratio of 2.13 (95% CI, 1.58-2.73; P≤0.001) for death after 6 months. The risk association of the MPI with mortality remained significant in multivariate analysis including risk factors, such as peripheral artery disease and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. CONCLUSIONS A comprehensive geriatric assessment with the MPI score provides additional information on mortality risk beyond established cardiovascular risk factors.
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Affiliation(s)
- Matthieu Schäfer
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Maria I Körber
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rakave Vimalathasan
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Victor Mauri
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Christos Iliadis
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Clemens Metze
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Henrik Ten Freyhaus
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Stephan Baldus
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne (M.C.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Ageing-Associated Diseases (CECAD) (M.C.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Roman Pfister
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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Khan MU, Khan MZ, Khan SU, Kaluski E. Transcatheter mitral valve repair in patients with chronic liver disease: Insights from the national inpatient sample. Catheter Cardiovasc Interv 2021; 97:344-352. [PMID: 32770731 DOI: 10.1002/ccd.29173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co-existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR). METHODS The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between January 2012 and December 2017. Propensity match analysis was done to compare it to subjects without underlying CLD. Logistic regression analysis was used to identify predictors of in-hospital mortality. RESULTS Of 15,270 patients undergoing TMVR, 569 (3.7%) had coexisting CLD. Patients with CLD had a higher proportion of males (61.3 vs 52.6%; p < .01), congestive heart failure (6.9 vs 1.0%; p < .01), renal failure (42.2 vs 36.7%; p < .01), and peripheral vascular disease (19.3 vs 12.5%; p < .01). After propensity matching subjects with CLD had significantly higher hospital mortality (19.8 vs 4.6%; p < .01), acute kidney injury (46.1 vs 37.8%; p < .01), cardiogenic shock (25.4 vs 12.1%; p < .01), mechanical ventilation (26.3 vs 14.0; p < .01), pneumothorax (6.6 vs <2%.; p < .01), length of stay (5 vs 9 days), and average cost of hospitalization (209,573 vs 250,587 $; p < .01). Over the years, in-hospital mortality in patients receiving TMVR has improved in both patients with (from 33.3 in 2013 to 22.2% in 2017) and without CLD (from 2.7 in 2011 to 1.6% in 2017). CONCLUSION Patients with MR undergoing TMVR, with coexisting CLD bear substantially higher comorbidities, complication rates, and inpatient mortality compared with those without CLD. A favorable temporal trend of in-hospital mortality among these subjects is noteworthy.
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Affiliation(s)
- Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Z Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Edo Kaluski
- Guthrie Clinic/Robert Packer Hospital, Sayre, Pennsylvania, USA.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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Ben-Shoshan J, Overtchook P, Buithieu J, Mousavi N, Martucci G, Spaziano M, de Varennes B, Lachapelle K, Brophy J, Modine T, Baumbach A, Maisano F, Prendergast B, Tamburino C, Windecker S, Piazza N. Predictors of Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair. JACC Cardiovasc Interv 2020; 13:1733-1748. [DOI: 10.1016/j.jcin.2020.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/20/2023]
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Paulus MG, Meindl C, Böhm L, Holzapfel M, Hamerle M, Schach C, Maier LS, Debl K, Unsöld B, Birner C. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PLoS One 2020; 15:e0232817. [PMID: 32463820 PMCID: PMC7255600 DOI: 10.1371/journal.pone.0232817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/22/2020] [Indexed: 01/11/2023] Open
Abstract
Background and objectives MitraClip implantation is an established therapy for secondary mitral regurgitation (MR) in high-risk patients and has shown to improve several important outcome parameters such as functional capacity. Patient selection is both challenging and crucial for achieving therapeutic success. This study investigated baseline predictors of functional improvement as it was quantified by the six-minute walk distance (6MWD) after transcatheter mitral valve repair. Methods and results We retrospectively analyzed 79 patients with secondary MR treated with MitraClip implantation at an academic tertiary care center. Before and four weeks after the procedure, all patients underwent comprehensive clinical assessment, six-minute walk tests and echocardiography. 6MWD significantly improved after MitraClip therapy (295 m vs. 265 m, p < 0.001). A linear regression model including seven clinical baseline variables significantly predicted the change in 6MWD (p = 0.002, R2 = 0.387). Female gender, diabetes mellitus and arterial hypertension were found to be significant negative predictors of 6MWD improvement. At baseline, female patients had significant higher left ventricular ejection fraction (49% vs. 42%, p = 0.019) and lower 6MWD (240 m vs. 288 m, p = 0.034) than male patients. Conclusion MitraClip implantation in secondary MR significantly improves functional capacity in high-risk patients even in the short term of four weeks after the procedure. Female gender, diabetes mellitus and arterial hypertension are baseline predictors of a less favourable functional outcome. While further validation in a larger cohort is recommended, these parameters may improve patient selection for MitraClip therapy.
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Affiliation(s)
- Michael G. Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Böhm
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Magdalena Holzapfel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
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Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation. J Clin Med 2020; 9:jcm9051348. [PMID: 32380651 PMCID: PMC7290430 DOI: 10.3390/jcm9051348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
The management of mitral valve regurgitation (MR), a common valve disease, represents a challenge in clinical practice, since the indication for either surgical or percutaneous valve replacement or repair are guided by symptoms and by echocardiographic parameters which are not always feasible. In this complex scenario, the use of natriuretic peptide (NP) levels would serve as an additive diagnostic and prognostic tool. These biomarkers contribute to monitoring the progression of the valve disease, even before the development of hemodynamic consequences in a preclinical stage of myocardial damage. They may contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations, thus requiring surgical management rather than a conservative approach. This article provides a comprehensive overview of the available evidence on the role of NPs in the management, risk evaluation, and prognostic assessment of patients with MR both before and after surgical or percutaneous valve repair. Despite largely positive evidence, a series of controversial findings exist on this relevant topic. Recent clinical trials failed to assess the role of NPs following the interventional procedure. Future larger studies are required to enable the introduction of NP levels into the guidelines for the management of MR.
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Kundi H, Popma JJ, Valsdottir LR, Shen C, Faridi KF, Pinto DS, Yeh RW. The Value of Claims-Based Nontraditional Risk Factors in Predicting Long-term Mortality After MitraClip Procedure. Can J Cardiol 2018; 34:1648-1654. [PMID: 30527154 DOI: 10.1016/j.cjca.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/06/2018] [Accepted: 10/07/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We sought to identify nontraditional risk factors coded in administrative claims data and evaluate their ability to improve prediction of long-term mortality in patients undergoing percutaneous mitral valve repair. METHODS Patients undergoing transcatheter mitral valve repair using MitraClip implantation between September 28, 2010, and September 30, 2015 were identified among Medicare fee-for-service beneficiaries. We used nested Cox regression models to identify claims codes predictive of long-term mortality. Four groups of variables were introduced sequentially: cardiac and noncardiac risk factors, presentation characteristics, and nontraditional risk factors. RESULTS A total of 3782 patients from 280 clinical sites received treatment with MitraClip over the study period. During the follow-up period, 1114 (29.5%) patients died with a median follow-up time period of 13.6 (9.6 to 17.3) months. The discrimination of a model to predict long-term mortality including only cardiac risk factors was 0.58 (0.55 to 0.60). Model discrimination improved with the addition of noncardiac risk factors (c = 0.63, 0.61 to 0.65; integrated discrimination improvement [IDI] = 0.038, P < 0.001), and with the subsequent addition of presentation characteristics (c = 0.67, 0.65 to 0.69; IDI = 0.033, P < 0.001 compared with the second model). Finally, the addition of nontraditional risk factors significantly improved model discrimination (c = 0.70, 0.68 to 0.72; IDI = 0.019, P < 0.001, compared with the third model). CONCLUSIONS Risk-prediction models, which include nontraditional risk factors as identified in claims data, can be used to predict long-term mortality risk more accurately in patients who have undergone MitraClip procedures.
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Affiliation(s)
- Harun Kundi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Jeffrey J Popma
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Linda R Valsdottir
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Kamil F Faridi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Duane S Pinto
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
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Keßler M, Pott A, Mammadova E, Seeger J, Wöhrle J, Rottbauer W, Markovic S. Atrial Fibrillation Predicts Long-Term Outcome after Transcatheter Edge-to-Edge Mitral Valve Repair by MitraClip Implantation. Biomolecules 2018; 8:biom8040152. [PMID: 30463247 PMCID: PMC6316291 DOI: 10.3390/biom8040152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Atrial fibrillation is common in patients with mitral regurgitation (MR) and has a negative impact on the clinical outcome of patients with valvular heart disease. We aimed to evaluate the impact of pre-procedural atrial fibrillation on the long-term clinical outcomes of patients with MR undergoing transcatheter mitral valve repair by MitraClip implantation. Methods: We analysed 355 consecutive patients with and without atrial fibrillation with symptomatic, severe MR and inoperability or high surgical risk undergoing MitraClip implantation in a three-year follow-up. Results: In patients with pre-procedural atrial fibrillation undergoing MitraClip implantation, we found advanced age, higher baseline NT-pro-BNP levels, increased left atrial diameter, and higher rate of severe tricuspid regurgitation, compared to patients with sinus rhythm. In the three-year follow-up after MitraClip implantation, mortality and major adverse cardiovascular and cerebral events (MACCE) occur significantly more often in patients with atrial fibrillation, compared to patients without atrial fibrillation. Multivariate regression analysis confirmed atrial fibrillation (hazard ratio 2.39, 95%-confidence interval 1.06–5.41, p = 0.036) as an independent predictor for three-year-mortality after MitraClip implantation. Conclusions: Atrial fibrillation is an independent predictor for long-term mortality after MitraClip implantation. We demonstrate the association of atrial fibrillation with mortality and MACCE in the long-term follow-up of patients undergoing MitraClip implantation.
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Affiliation(s)
- Mirjam Keßler
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Alexander Pott
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Elnura Mammadova
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Julia Seeger
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Jochen Wöhrle
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
| | - Sinisa Markovic
- Department of Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
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11
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Invasive hemodynamics and cardiac biomarkers to predict outcomes after percutaneous edge-to-edge mitral valve repair in patients with severe heart failure. Clin Res Cardiol 2018; 108:375-387. [PMID: 30191296 DOI: 10.1007/s00392-018-1365-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/30/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) via MitraClip implantation is a therapeutic option for high-risk or non-surgical candidates with severe mitral regurgitation (MR) and advanced stages of heart failure (HF). However, these patients have a high mortality despite PMVR, and predictors for outcomes are not well established. Here, we evaluated invasive hemodynamics, echocardiography parameters, and biomarkers to predict outcomes after PMVR in severe HF patients. METHODS Patients with reduced ejection fraction (EF) and severe and moderate-to-severe MR undergoing PMVR at our centre between September 2009 and January 2016 were analysed retrospectively. Inclusion criteria were: left ventricular EF < 45%, preoperative right heart catheterization, successful MitraClip deployment ("technical success"), and follow-up for at least 1 year after the procedure. Data from preoperative right heart catheterization, echocardiography, and biomarkers were assessed. Primary endpoint was all-cause mortality at 1 year after PMVR. We performed univariate and multivariate Cox regression analyses and generated a risk score to predict outcomes. RESULTS Of 174 patients with PMVR and severe HF, 79.9% had functional MR. Mean EF was 25% (17.2; 30.7) and advanced New York Heart Association functional class was prevalent (class II: 13%; class III: 70%; and class IV: 17%). The cumulative incidences of all-cause death were 6.9% and 17.8% at 30 days and 1 year, respectively. In the Cox multivariate model, high-sensitive troponin T [hsTnT; hazard ratio (HR) 1.01; confidence interval (CI) 1.01-1.02; p < 0.0001] and mixed venous O2-saturation (HR 0.92; CI 0.89-0.96; p < 0.0001) were found to significantly and independently predict outcomes. A simple risk score including these two parameters was sufficient to discriminate between low- and high-risk patients (HR 7.22; CI 3.4-15.5; p < 0.001). CONCLUSION In a cohort of patients with severe HF undergoing PMVR, patients with elevated hsTnT and reduced mixed venous O2-saturation carried the worst prognosis. A simple risk score including these two parameters may improve patient selection and outcomes after PMVR.
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12
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Kar S, Feldman T, Qasim A, Trento A, Kapadia S, Pedersen W, Lim DS, Kipperman R, Smalling RW, Bajwa T, Hermann HC, Hermiller JB, Lasala JM, Reisman M, Glower D, Mauri L, Whitlow P. Five-year outcomes of transcatheter reduction of significant mitral regurgitation in high-surgical-risk patients. Heart 2018; 105:1622-1628. [DOI: 10.1136/heartjnl-2017-312605] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 11/03/2022] Open
Abstract
ObjectivesThis study evaluates the 5-year clinical outcomes of transcatheter mitral valve (MV) repair with the MitraClip device in patients at high risk for MV surgery treated in the Endovascular Valve Edge-to-Edge Repair (EVEREST) II High Risk Study (HRS).MethodsPatients with mitral regurgitation (MR) 3+ or 4+ and predicted surgical mortality risk ≥12% or surgeon assessment based on prespecified high-risk factors were enrolled. Patients prospectively consented to 5 years of follow-up.ResultsAt 5 years, clinical follow-up was achieved in 90% of 78 enrolled patients. The rate of postprocedural adverse events declined from 30 days to 1 year follow-up and was stable thereafter through 5 years. Two patients (2.6%) developed mitral stenosis (MS). Two patients underwent MV surgery, including one due to MS. A total of 42 deaths were reported through 5 years. Effectiveness measures at 5 years showed reductions in MR severity to ≤2+ in 75% of patients (p=0.0107), left ventricular (LV) end-diastolic volume (−38.2 mL; 95% CI −55.0 to –21.4; p<0.0001) and LV end-systolic volume (−14.6 mL; 95% CI −27.7 to −1.5; p=0.0303) compared with baseline. The New York Heart Association (NYHA) functional class improved from baseline to 5 years (p<0.005), and septal-lateral annular dimensions remained stable with no indication of mitral annular dilation through 5 years.ConclusionsThe EVEREST II HRS demonstrated long-term safety and efficacy of MitraClip in high-surgical-risk patients through 5 years. The observed mortality was most likely a consequence of the advanced age and comorbidity profile of the enrolled patients, while improvements in NYHA class in surviving patients were durable through long-term follow-up.Trial registration numberNCT01940120.
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13
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Kortlandt F, Velu J, Schurer R, Hendriks T, Van den Branden B, Bouma B, Feldman T, Kelder J, Bakker A, Post M, Van der Harst P, Eefting F, Swaans M, Rensing B, Baan J, Van der Heyden J. Survival After MitraClip Treatment Compared to Surgical and Conservative Treatment for High-Surgical-Risk Patients With Mitral Regurgitation. Circ Cardiovasc Interv 2018; 11:e005985. [DOI: 10.1161/circinterventions.117.005985] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Friso Kortlandt
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Juliette Velu
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Remco Schurer
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Tom Hendriks
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Ben Van den Branden
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands (B.V.d.B.)
| | - Berto Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Ted Feldman
- Department of Cardiology, Evanston Hospital, NorthShore University Health System, IL (T.F.)
| | - Johannes Kelder
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Annelies Bakker
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Marco Post
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Pim Van der Harst
- Department of Cardiology, University Medical Center, Groningen, the Netherlands (R.S., T.H., P.V.d.H.)
| | - Frank Eefting
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Martin Swaans
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Benno Rensing
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
| | - Jan Baan
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (J.V., B.B., J.B.)
| | - Jan Van der Heyden
- From the Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands (F.K., J.K., A.B., M.P., F.E., M.S., B.R., J.V.d.H.)
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14
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Impact of Frailty on Outcomes in Patients Undergoing Percutaneous Mitral Valve Repair. JACC Cardiovasc Interv 2017; 10:1920-1929. [DOI: 10.1016/j.jcin.2017.07.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/17/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022]
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15
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Mendirichaga R, Singh V, Blumer V, Rivera M, Rodriguez AP, Cohen MG, O'Neill WW, Elmariah S. Transcatheter Mitral Valve Repair With MitraClip for Symptomatic Functional Mitral Valve Regurgitation. Am J Cardiol 2017. [PMID: 28645469 DOI: 10.1016/j.amjcard.2017.05.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Transcatheter edge-to-edge mitral valve repair (TMVr) with MitraClip has proved to be safe and effective for high-risk surgical patients with severe symptomatic degenerative mitral regurgitation. There is paucity of data regarding its use in functional mitral regurgitation (FMR). The objective of this study was to evaluate the use of MitraClip in patients with symptomatic moderate or severe FMR and a high surgical risk. Medical libraries were systematically searched for studies assessing the use of MitraClip for patients with symptomatic moderate or severe FMR and a high surgical risk. Studies reporting safety and efficacy outcomes at 12 months were included in the analysis. A total of 12 studies including 1,695 patients (age 73 [interquartile range [IQR] 70.5 to 74], 69.8% men, left ventricular ejection fraction 32.5% [IQR 29.5 to 36], New York Heart Association class II to IV) who underwent TMVr with MitraClip were included in the analysis. Acute procedural success was 89% (IQR 85.5 to 92). Ischemic cardiomyopathy was the most common cause of left ventricular dysfunction. Over 2/3 of patients had known coronary artery disease, 35% a previous myocardial infarction, and 38.5% had a previous cardiac surgery. Survival to hospital discharge was 98% (IQR 97 to 100) and 30-day survival 97% (IQR 96 to 98). Overall survival at 12 months was 82% (IQR 77 to 87). Mitral valve re-intervention at 12 months was infrequent (3%; IQR 2 to 6.5). In conclusion, our pooled analysis suggests that TMVr with MitraClip is feasible, safe, and carries a low rate of mitral valve re-intervention at 12 months in patients with symptomatic moderate or severe FMR and a high surgical risk.
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Affiliation(s)
- Rodrigo Mendirichaga
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Vikas Singh
- Structural Heart Diseases, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Vanessa Blumer
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Manuel Rivera
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Alex P Rodriguez
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida
| | - William W O'Neill
- Structural Heart Diseases, Cardiology Division, Henry Ford Hospital, Detroit, Michigan
| | - Sammy Elmariah
- Structural Heart Diseases, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Buccheri S, Capodanno D, Barbanti M, Popolo Rubbio A, Di Salvo ME, Scandura S, Mangiafico S, Ronsivalle G, Chiarandà M, Capranzano P, Grasso C, Tamburino C. A Risk Model for Prediction of 1-Year Mortality in Patients Undergoing MitraClip Implantation. Am J Cardiol 2017; 119:1443-1449. [PMID: 28274574 DOI: 10.1016/j.amjcard.2017.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Abstract
There is a lack of specific tools for risk stratification in patients who undergo MitraClip implantation. We aimed at combining preprocedural variables with prognostic impact into a specific risk model for the prediction of 1-year mortality in patients undergoing MitraClip implantation. A total of 311 consecutive patients who underwent MitraClip implantation were included. A lasso-penalized Cox-proportional hazard regression model was used to identify independent predictors of 1-year all-cause mortality. A nomogram (GRASP [Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation] nomogram) was obtained from the Cox model. Validation was performed using internal bootstrap resampling. Forty-two deaths occurred at 1-year follow-up. The Kaplan-Meier estimate of 1-year survival was 0.845 (95% confidence interval, 0.802 to 0.895). Four independent predictors of mortality (mean arterial blood pressure, hemoglobin natural log-transformed pro-brain natriuretic peptide levels, New York Heart Association class IV at presentation) were identified. At internal bootstrap resampling validation, the GRASP nomogram had good discrimination (area under receiver operating characteristic curve of 0.78, Somers' Dxy statistic of 0.53) and calibration (le Cessie-van Houwelingen-Copas-Hosmer p value of 0.780). Conversely, the discriminative ability of the EuroSCORE II (the European System for Cardiac Operative Risk Evaluation II) and the STS-PROM (the Society of Thoracic Surgeons Predicted Risk of Mortality score) was fairly modest with area under the curve values of 0.61 and 0.55, respectively. A treatment-specific risk model in patients who undergo MitraClip implantation may be useful for the stratification of mortality at 1 year. Further studies are needed to provide external validation and support the generalizability of the GRASP nomogram.
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Affiliation(s)
- Sergio Buccheri
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Maria Elena Di Salvo
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Salvatore Scandura
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Sarah Mangiafico
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuseppe Ronsivalle
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marta Chiarandà
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Carmelo Grasso
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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Öner A, Ince H, Paranskaya L, Schröder G, Sherif M, Thiele O, Neuhausen A, Kische S, Ortak J, D′Ancona G. Previous malignancy is an independent predictor of follow-up mortality after percutaneous treatment of mitral valve regurgitation by means of MitraClip. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/21/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Alper Öner
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Hüseyin Ince
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Liliya Paranskaya
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Guido Schröder
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Mohammad Sherif
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Olga Thiele
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Alla Neuhausen
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Stephan Kische
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Jasmin Ortak
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
| | - Giuseppe D′Ancona
- Heart Center Rostock; Rostock School of Medicine; University Hospital Rostock; Rostock Germany
- Department of Cardiology; Vivantes Klinikum im Friedrichshain und Am Urban; Berlin Germany
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18
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Gotzmann M, Sprenger I, Ewers A, Mügge A, Bösche L. One-year outcome of percutaneous mitral valve repair in patients with severe symptomatic mitral valve regurgitation. World J Cardiol 2017; 9:39-46. [PMID: 28163835 PMCID: PMC5253193 DOI: 10.4330/wjc.v9.i1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/30/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate one-year outcomes after percutaneous mitral valve repair with MitraClip® in patients with severe mitral regurgitation (MR).
METHODS
Our study investigated consecutive patients with symptomatic severe MR who underwent MitraClip® implantation at the University Hospital Bergmannsheil from 2012 to 2014. The primary study end-point was all-cause mortality. Secondary end-points were degree of MR and functional status after percutaneous mitral valve repair.
RESULTS The study population consisted of 46 consecutive patients (mean logistic EuroSCORE 32% ± 21%). The degree of MR decreased significantly (severe MR before MitraClip® 100% vs after MitraClip® 13%; P < 0.001), and the NYHA functional classes improved (NYHA III/IV before MitraClip® 98% vs after MitraClip® 35%; P < 0.001). The mortality rates 30 d and one year after percutaneous mitral valve repair were 4.3% and 19.5%, respectively. During the follow-up of 473 ± 274 d, 11 patients died (90% due to cardiovascular death). A pre-procedural plasma B-type natriuretic peptide level > 817 pg/mL was associated with all-cause mortality (hazard ratio, 6.074; 95%CI: 1.257-29.239; P = 0.012).
CONCLUSION Percutaneous mitral valve repair with MitraClip® has positive effects on hemodynamics and symptoms. Despite the study patients’ multiple comorbidities and extremely high operative risk, one-year outcomes after MitraClip® are favorable. Elevated B-type natriuretic peptide levels indicate poorer mid-term survival.
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19
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Inderbitzin DT, Taramasso M, Nietlispach F, Maisano F. Percutaneous Mitral Valve Repair with MitraClip: Patient and Valve Selection for Optimal Outcome. Curr Cardiol Rep 2016; 18:129. [PMID: 27796866 DOI: 10.1007/s11886-016-0809-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the real world of mitral regurgitation, the patient selection process for MitraClip (Abbott, Abbott Park, IL, USA) to achieve optimal outcome has become a challenge. With the opening of the Endovascular Valve Edge-to-Edge Repair Study criteria, the implant experience was extended towards functional mitral regurgitation and anatomically more complex mitral pathologies in many centers worldwide. We provide a review of the current literature to identify an appropriate patient selection process for MitraClip therapy and suggest a simple two-dimensional decision-making algorithm.
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Affiliation(s)
- Devdas T Inderbitzin
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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20
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Velu J, Bouma B, Koch K, Vis M, Baan J. High sensitive Troponin T useful in clinical decision making for MitraClip implantation. Int J Cardiol 2016; 220:614-5. [DOI: 10.1016/j.ijcard.2016.06.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/28/2016] [Indexed: 11/26/2022]
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Adamo M, Chiari E, Curello S, Maiandi C, Chizzola G, Fiorina C, Frontini M, Cuminetti G, Pezzotti E, Rovetta R, Lombardi CM, Manzato A, Metra M, Ettori F. Mitraclip therapy in patients with functional mitral regurgitation and missing leaflet coaptation: is it still an exclusion criterion? Eur J Heart Fail 2016; 18:1278-1286. [DOI: 10.1002/ejhf.520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 02/01/2016] [Accepted: 02/12/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marianna Adamo
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Ermanna Chiari
- Echocardiographic Laboratory; Spedali Civili; Brescia Italy
| | - Salvatore Curello
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | | | - Giuliano Chizzola
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Claudia Fiorina
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Mario Frontini
- Division of Cardiothoracic Anaesthesiology, Cardiothoracic Department, Spedali Civili; Brescia; Italy
| | - Giovanni Cuminetti
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Elena Pezzotti
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Riccardo Rovetta
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
| | - Carlo Mario Lombardi
- Cardiology, Cardiothoracic Department; Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Italy
| | - Aldo Manzato
- Division of Cardiothoracic Anaesthesiology, Cardiothoracic Department, Spedali Civili; Brescia; Italy
| | - Marco Metra
- Cardiology, Cardiothoracic Department; Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Italy
| | - Federica Ettori
- Catheterization Laboratory; Cardiothoracic Department, Spedali Civili; Brescia Italy
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22
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Kortlandt FA, de Beenhouwer T, Swaans MJ, Post MC, van der Heyden JAS, Eefting FD, Rensing BJWM. Mortality after percutaneous edge-to-edge mitral valve repair: a contemporary review. Cardiovasc Diagn Ther 2016; 6:160-5. [PMID: 27054105 DOI: 10.21037/cdt.2016.02.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Percutaneous edge-to-edge mitral valve (MV) repair is a relatively new treatment option for mitral regurgitation (MR). After the feasibility and safety having been proved in low-surgical-risk patients, the use of this procedure has shifted more to the treatment of high-risk patients. With the absence of randomized controlled trials (RCT) for this particular subgroup, observational studies try to add evidence to the safety aspect of this procedure. These also provide short- and mid-term mortality figures. Several mortality predictors have been identified, which may help the optimal selection of patients who will benefit most from this technique. In this article we provide an overview of the literature about mortality and its predictors in patients treated with the percutaneous edge-to-edge device.
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Affiliation(s)
- Friso A Kortlandt
- Department of Cardiology, St. Antonius hospital, Nieuwegein, The Netherlands
| | | | - Martin J Swaans
- Department of Cardiology, St. Antonius hospital, Nieuwegein, The Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius hospital, Nieuwegein, The Netherlands
| | | | - Frank D Eefting
- Department of Cardiology, St. Antonius hospital, Nieuwegein, The Netherlands
| | - Benno J W M Rensing
- Department of Cardiology, St. Antonius hospital, Nieuwegein, The Netherlands
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