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Halboni A, Hamza M, Dayco J, Al-Abcha A, Alhalbouni A, Zghouzi M, Alhusain R, Sattar Y, Alraies MC. Outcomes of Transcatheter Mitral Valve Repair Using the MitraClip System in Patients With Atrial Fibrillation. A Meta-Analysis. Am J Cardiol 2024; 219:47-59. [PMID: 37865125 DOI: 10.1016/j.amjcard.2023.09.057] [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: 05/26/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
Transcatheter mitral valve repair (TMVR) with the MitraClip system is now approved for degenerative and functional mitral regurgitation (MR). Atrial fibrillation (AF) is commonly seen in MR. In our study, we perform a pooled analysis of the existing data to investigate the outcomes of MitraClip in patients with versus without AF. We conducted a systematic search of PubMed, Google Scholar, and SCOPUS databases through December, 2022 for studies comparing the outcomes of TMVR using the MitraClip in patients with preexisting AF versus those without AF. A meta-analysis was performed to investigate the primary outcomes of all-cause mortality and heart failure (HF) hospitalization. Secondary outcomes were cardiovascular mortality, in-hospital mortality, stroke, New York Heart Association class I or II at follow-up, length of hospital stay, and procedural time. A total of 10 studies (n = 24,111; AF = 12,789; no AF = 11,322) were included in the final analysis. Preexisting AF was associated with higher overall all-cause mortality (odds ratio 1.55, 95% confidence interval 1.32 to 1.83, p <0.0002) and higher overall HF hospitalization rate (odds ratio 1.3, 95% confidence interval 1.08 to 1.56, p <0.0154). There was no statistically significant difference in cardiovascular mortality, in-hospital mortality, stroke, length of hospital stay, procedural time, or New York Heart Association class I/II at follow-up comparing AF versus no AF. The presence of AF in patients who underwent TMVR with MitraClip is associated with higher all-cause mortality and HF hospitalization. This should be taken into consideration in the management of MR patients.
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Affiliation(s)
- Adnan Halboni
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Mohammad Hamza
- Department of Medicine, Albany Medical Center, Albany, New York
| | - John Dayco
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Abdallah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Mohamed Zghouzi
- Division of Vascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rashid Alhusain
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan
| | - Yasar Sattar
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, Detroit, Michigan.
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Dimitriadis K, Stathakopoulou C, Pyrpyris N, Beneki E, Adamopoulou E, Soulaidopoulos S, Leontsinis I, Kasiakogias A, Papanikolaou A, Tsioufis P, Aznaouridis K, Tsiachris D, Aggeli K, Tsioufis K. Interventional management of mitral regurgitation and sleep disordered breathing: "Catching two birds with one stone". Sleep Med 2024; 113:157-164. [PMID: 38029624 DOI: 10.1016/j.sleep.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
Sleep disordered breathing (SDB), mostly constituting of obstructive and central sleep apnea (OSA and CSA, respectively), is highly prevalent in the general population, and even more among patients with cardiovascular disease, heart failure (HF) and valvular heart disease, such as mitral regurgitation (MR). The coexistence of HF, MR and SDB is associated with worse cardiovascular outcomes and increased morbidity and mortality. Pulmonary congestion, as a result of MR, can exaggerate and worsen the clinical status and symptoms of SDB, while OSA and CSA, through various mechanisms that impair left ventricular dynamics, can promote left ventricular remodelling, mitral annulus dilatation and consequently MR. Regarding treatment, positive airway pressure devices used to ameliorate symptoms in SDB also seem to result in a reduction of MR severity, MR jet fraction and an improvement of left ventricular ejection fraction. However, surgical and transcatheter interventions for MR, and especially transcatheter edge to edge mitral valve repair (TEER), seem to also have a positive effect on SDB, by reducing OSA and CSA-related severity indexes and improving symptom control. The purpose of this review is to provide a comprehensive analysis of the common pathophysiology between SDB and MR, as well as to discuss the available evidence regarding the effect of SDB treatment on MR and the effect of mitral valve surgery or transcatheter repair on both OSA and CSA.
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Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Christina Stathakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Eirini Beneki
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Elena Adamopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
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Ausbuettel F, Barth S, Chatzis G, Fischer D, Kerber S, Mueller J, List S, Halbfass P, Deneke T, Nef H, Mueller HH, Divchev D, Schieffer B, Luesebrink U, Waechter C. Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair. Front Cardiovasc Med 2023; 10:1229651. [PMID: 37645518 PMCID: PMC10461005 DOI: 10.3389/fcvm.2023.1229651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Background Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) and detrimentally affects their outcome. While there is increasing evidence for prognostic improvement and safety of catheter ablation (CA) of AF in the overall cohort of heart failure patients, corresponding data in TEER patients are lacking. Objectives To investigate the impact of treatment regimens for concomitant AF on survival of TEER patients. Methods In a multicenter observational cohort study consecutive patients successfully undergoing TEER were analyzed and survival of patients receiving CA of concomitant AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching (PSM). Results A total of 821 patients were analyzed. Of these, 608 (74.1%) had concomitant AF, of whom 48 patients received CA. Patients with CA in AF showed significantly higher 3-year-survival after TEER compared to PSM-patients on pharmacological AF treatment (75.5% [36/48] vs. 49.4% [166/336], p = 0.009). The 3-year-survival after TEER of patients with concomitant AF treated with CA was not significantly different from PSM-patients without AF (75.5% [36/48] vs. 68.3% [98/144], p = 0.36). Conclusions CA of AF is superior to pharmacotherapy as it significantly improves the survival of TEER patients in a PSM analysis. CA even offsets the prognostic disadvantage of coexisting AF in TEER patients. Given the growing evidence of prognostic benefits in the overall cohort of HF patients, our data point out the importance of treating concomitant AF and support CA as an essential part of a holistic management of TEER patients.
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Affiliation(s)
- Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Stephan List
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Philipp Halbfass
- Department of Cardiology, University Hospital Oldenburg, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Bad Neustadt an der Saale, Germany
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Rotenburg an der Fulda, Germany
- Department of Cardiology, University Hospital Gießen, Justus Liebig University Gießen, Gießen, Germany
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University Marburg, Marburg, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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Waechter C, Ausbuettel F, Chatzis G, Cheko J, Fischer D, Nef H, Barth S, Halbfass P, Deneke T, Kerber S, Kikec J, Mueller HH, Divchev D, Schieffer B, Luesebrink U. Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Clin Med 2021; 10:5044. [PMID: 34768567 PMCID: PMC8584691 DOI: 10.3390/jcm10215044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1-2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Felix Ausbuettel
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Georgios Chatzis
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Dieter Fischer
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
| | - Holger Nef
- Department of Cardiology, Cardiovascular Center Rotenburg/Fulda, Heinz-Meise-Straße 100, 36199 Rotenburg/Fulda, Germany; (D.F.); (H.N.)
- Department of Cardiology, University Hospital Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | - Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, 97616 Bad Neustadt/Saale, Germany; (S.B.); (P.H.); (T.D.); (S.K.); (J.K.)
| | - Hans-Helge Mueller
- Institute for Bioinformatics and Biostatistics, Philipps University, Bunsenstraße 3, 35037 Marburg, Germany;
| | - Dimitar Divchev
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Baldingerstraße, 35043 Marburg, Germany; (C.W.); (F.A.); (G.C.); (J.C.); (D.D.); (B.S.)
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Aranzulla TC, Musumeci G. Clipping mitral valve or atrial fibrillation? Two is better than one! Catheter Cardiovasc Interv 2021; 97:1257-1258. [PMID: 33974743 DOI: 10.1002/ccd.29727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | - Giuseppe Musumeci
- Cardiology Department, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Italy
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