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Kaneko T, Kagiyama N, Nakamura Y, Dotare T, Sunayama T, Ishiwata S, Maeda D, Iso T, Kato T, Suda S, Hiki M, Matsue Y, Kasai T, Minamino T. Usefulness of HANBAH Score in Japanese Patients With Acute Heart Failure. Am J Cardiol 2023; 203:45-52. [PMID: 37481811 DOI: 10.1016/j.amjcard.2023.06.114] [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: 01/14/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
The HANBAH score is a novel simple risk score consisting of hemoglobin level, age, sodium (N) level, blood urea nitrogen level, atrial fibrillation, and high-density lipoprotein. We aimed to validate this score in an external population. This retrospective study included 744 patients hospitalized for acute heart failure between 2015 and 2019. Each of the following criteria was scored as 1 point: hemoglobin level (<13.0 g/L for men and <12.0 g/L for women), atrial fibrillation, age (>70 years), serum blood urea nitrogen level (>26 mg/100 ml for men and >28 mg/100 ml for women), serum high-density lipoprotein level (<25 mg/100 ml), and serum sodium level (<135 mg/100 ml). HANBAH scores were available for 736 patients (age, 75 ± 13 years; 60% male; reduced [<40%] and preserved ejection fraction [≥50%]: 35% and 49%, respectively). All-cause death during follow-up, a composite of death and heart failure rehospitalization, and in-hospital death were observed in 173, 274, and 51 patients, respectively. The HANBAH score was significantly associated with these end points after adjustment for covariates (adjusted hazard ratio 1.38 [95% confidence interval 1.16 to 1.64], p <0.001; 1.27 [1.11 to 1.45], p <0.001; and 1.66 [1.18 to 2.33], p <0.001, respectively). Receiver operating characteristic and net reclassification improvement analyses showed that the HANBAH score performed significantly better than AHEAD (atrial fibrillation, hemoglobin [anemia], elderly, abnormal renal parameters, diabetes mellitus) and AHEAD-U (AHEAD with uric acid) scores and similar to the multi-domain ACUTE HF score for all end points. In conclusion, the HANBAH score showed powerful risk stratification in this external Japanese cohort. Despite its simplicity, it performed better than other simple risk scores and similar to a multidomain risk score.
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Affiliation(s)
- Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Osswald A, Shehada SE, Zubarevich A, Kamler M, Thielmann M, Sommer W, Weymann A, Ruhparwar A, El Gabry M, Schmack B. Short-term mechanical support with the Impella 5.x for mitral valve surgery in advanced heart failure-protected cardiac surgery. Front Cardiovasc Med 2023; 10:1229336. [PMID: 37547249 PMCID: PMC10400355 DOI: 10.3389/fcvm.2023.1229336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Surgical treatment of patients with mitral valve regurgitation and advanced heart failure remains challenging. In order to avoid peri-operative low cardiac output, Impella 5.0 or 5.5 (5.x), implanted electively in a one-stage procedure, may serve as a peri-operative short-term mechanical circulatory support system (st-MCS) in patients undergoing mitral valve surgery. Methods Between July 2017 and April 2022, 11 consecutive patients underwent high-risk mitral valve surgery for mitral regurgitation supported with an Impella 5.x system (Abiomed, Inc. Danvers, MA). All patients were discussed in the heart team and were either not eligible for transcatheter edge-to-edge repair (TEER) or surgery was considered favorable. In all cases, the indication for Impella 5.x implantation was made during the preoperative planning phase. Results The mean age at the time of surgery was 61.6 ± 7.7 years. All patients presented with mitral regurgitation due to either ischemic (n = 5) or dilatative (n = 6) cardiomyopathy with a mean ejection fraction of 21 ± 4% (EuroScore II 6.1 ± 2.5). Uneventful mitral valve repair (n = 8) or replacement (n = 3) was performed via median sternotomy (n = 8) or right lateral mini thoracotomy (n = 3). In six patients, concomitant procedures, either tricuspid valve repair, aortic valve replacement or CABG were necessary. The mean duration on Impella support was 8 ± 5 days. All, but one patient, were successfully weaned from st-MCS, with no Impella-related complications. 30-day survival was 90.9%. Conclusion Protected cardiac surgery with st-MCS using the Impella 5.x is safe and feasible when applied in high-risk mitral valve surgery without st-MCS-related complications, resulting in excellent outcomes. This strategy might offer an alternative and comprehensive approach for the treatment of patients with mitral regurgitation in advanced heart failure, deemed ineligible for TEER or with need of concomitant surgery.
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Affiliation(s)
- Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Kamler
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Wiebke Sommer
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mohamed El Gabry
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Hsiao CS, Hsiao SH, Chiou FR, Chiou KR. Early predicting improvement of severe systolic heart failure by left atrial volume. Heart Vessels 2023; 38:523-534. [PMID: 36409354 DOI: 10.1007/s00380-022-02199-5] [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: 07/04/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
Left atrium (LA) modulates left ventricle (LV) filling and cardiac performance. We aimed to assess the effect of heart failure (HF) therapy on LA and LV function, and the relationship between LA/LV improvement and clinical outcome in acute HF with reduced LV ejection fraction (LVEF). Totally, 224 hospitalized patients with acute HF and LVEF < 35% were enrolled and underwent echocardiography. They all received maximal tolerable doses of evidence-based medications. Patients received echocardiographic measurements at each visit including stroke volume, LVEF, LA minimal/maximal volume (LAVmin/LAVmax), LA expansion index, and tissue Doppler parameters. The threshold of LV functional improvement was LVEF > 45% ever occurred before study end. During the mean follow-up of 6.3 years, 62 cases improved well, mean LVEF 49 ± 5% at study end. The reduction of LV filling pressure occurring as early as 2 weeks later, LV systolic function improvement took longer (> 1 month). The reductions in LAVmin and LAVmax between initial stabilization and 2 weeks after HF treatment (Initial-2 W) and the increase of LA expansion index (Initial-2 W) were associated independently with LVEF improvement (p 0.002, 0.006, and 0.007, respectively). The best predictor of LVEF improvement was LAVmin reduction (Initial-2 W) > 5 ml with 77% sensitivity, 76% specificity. Cox proportional hazard regression analyses for cardiovascular events revealed LVEF improvement reduced 74% of events (hazard ratio 0.264, 95% CI 0.192-0.607, p < 0.0001); and LA expansion index (per 1% increase) reduced 14% of events (hazard ratio 0.862, 95% CI 0.771-0.959, p < 0.0001). The early reduction of LAV (Initial-2 W), especially LAVmin, is a powerful early predictor of LVEF improvement. Its occurrence reduces cardiovascular events significantly. ClinicalTrials.gov number: NCT01307722.
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Affiliation(s)
- Chao-Sheng Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fei-Ran Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuan-Rau Chiou
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,School of Medicine, Taipei Medical University, Taipei, Taiwan.
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Pagnesi M, Adamo M, Ter Maaten JM, Beldhuis IE, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Pang PS, Ponikowski P, Sama IE, Severin T, Gimpelewicz C, Voors AA, Teerlink JR, Metra M. Impact of mitral regurgitation in patients with acute heart failure: insights from the RELAX-AHF-2 trial. Eur J Heart Fail 2023; 25:541-552. [PMID: 36915227 DOI: 10.1002/ejhf.2820] [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: 12/08/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS The impact of mitral regurgitation (MR) in patients hospitalized for acute heart failure (AHF) is not well established. We assessed the role of MR in patients enrolled in the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial. METHODS AND RESULTS Patients enrolled in RELAX-AHF-2 with available data regarding MR status were included in this analysis. Baseline characteristics, in-hospital data, and clinical outcomes through 180-day follow-up were evaluated. The impact of moderate/severe MR was assessed. Among 6420 AHF patients with known MR status, 1810 patients (28.2%) had moderate/severe MR. Compared to patients with no/mild MR, those with moderate/severe MR were more likely to have history of heart failure (HF), prior HF hospitalization, more comorbidities, symptoms/signs of HF, lower left ventricular ejection fraction and higher N-terminal pro-B-type natriuretic peptide levels. Moderate/severe MR was associated with longer length of hospital stay, higher rates of residual dyspnoea, increased jugular venous pressure through the index hospitalization and a higher unadjusted risk of the composite of cardiovascular (CV) death or rehospitalization for HF/renal failure (RF) through 180 days (crude hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.03-1.27, p = 0.01). The association between moderate/severe MR and poorer outcomes was not maintained in a multivariable model including several covariates of interest (adjusted HR 1.03, 95% CI 0.91-1.17, p = 0.65). Similar findings were observed for HF/RF rehospitalization alone. CONCLUSIONS In patients with AHF, moderate/severe MR was associated with a worse clinical profile but did not have an independent prognostic impact on clinical outcomes.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jozine M Ter Maaten
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris E Beldhuis
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
| | | | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Gerasimos Filippatos
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Barry H Greenberg
- Division of Cardiology, University of California San Diego, San Diego, CA, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Iziah E Sama
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Kaneko T, Kagiyama N, Nakamura Y, Dotare T, Sunayama T, Ishiwata S, Maeda D, Iso T, Kato T, Suda S, Hiki M, Matsue Y, Kasai T, Minamino T. External validation of the ACUTE HF score for risk stratification in acute heart failure. Int J Cardiol 2023; 370:396-401. [PMID: 36270497 DOI: 10.1016/j.ijcard.2022.10.130] [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: 04/07/2022] [Revised: 09/16/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The ACUTE HF score is a simple risk score that predicts the prognosis of patients with acute heart failure (HF) using clinical and echocardiographic parameters. As this score was developed for a small European population, we aimed to validate this score in an external population. METHODS AND RESULTS This retrospective observational cohort analysis included patients hospitalized with acute HF during 2015-2019. Of 744 patients, 703 patients with available ACUTE HF scores were analyzed (75 ± 13 years; 61% male; left ventricular ejection fraction [LVEF] 49 ± 17%). Approximately one-third (34.4%) of the patients had reduced LVEF (<40%), and 51.4% exhibited preserved LVEF (≥50%). During a median follow-up of 452 days, primary and secondary outcomes were observed in 110 and 204 patients, respectively. The ACUTE HF score successfully stratified patients for primary (all-cause mortality) and secondary endpoints (a composite of all-cause mortality and heart failure rehospitalization) in Kaplan-Meier analyses (log-rank test, P < 0.001). Multivariable Cox proportional hazards models showed that the score was significantly independently associated with both primary and secondary endpoints after adjusted by covariates (P < 0.001). CONCLUSION We validated the risk prediction ability of ACUTE HF score in an Asian population. This score may be applicable in clinical practice.
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Affiliation(s)
- Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan; Department of Digital Health and Telemedicine R&D, Juntendo University, Japan.
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Japan
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Jiang GY, Xu J, Manning WJ, Markson LJ, Khabbaz KR, Garan AR, Sabe MA, Strom JB. Mitral Regurgitation and Mortality Risk in Medicare Beneficiaries With Heart Failure and Preserved Ejection Fraction. Am J Cardiol 2022; 183:40-47. [PMID: 36100504 DOI: 10.1016/j.amjcard.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/01/2022]
Abstract
The association of mitral regurgitation (MR) severity and mortality in heart failure with preserved ejection fraction (HFpEF) is uncertain. We sought to evaluate the relation between MR severity on transthoracic echocardiography (TTE) and subsequent all-cause mortality in Medicare beneficiaries with HFpEF. We linked 57,608 patients referred for TTE at Beth Israel Deaconess Medical Center to Medicare inpatient claims from 2003 to 2017. In those with a history of HF and a physician-reported left ventricular ejection fraction ≥50%, we evaluated the relation of MR severity and time to the primary end point of all-cause mortality using Kaplan-Meier methods. A total of 7,778 individuals (14.5%) met inclusion criteria (mean age 75.5 years ± 11.9, 55.9% female). Over a median follow-up of 8.1 years, 2,016 (25.9%) died at a median (interquartile range) of 1.7 (0.3 to 4.1) years. At 1 year, 15.8% with 3 to 4+ MR had died versus 10.5% with 0 to 2+ MR (hazard ratio 1.54, 95% confidence interval 1.22 to 1.95, p <0.001). After multivariable adjustment, 3 to 4+ MR continued to be associated with increased all-cause mortality (hazard ratio 1.48, 95% confidence interval 1.14 to 1.94, p = 0.004) except in the subset with atrial fibrillation (interaction p = 0.03) or recent (<3 months) HF hospitalization (p = 0.54). In conclusion, in this large, single-institution retrospective study of Medicare beneficiaries with HFpEF who underwent TTE, moderate-to-severe and severe MR were significantly associated with an increased risk of all-cause mortality after multivariable adjustment, except in those with atrial fibrillation or recent HF. Prospective studies are needed to assess the role of MR reduction in mitigating this risk.
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Affiliation(s)
- Ginger Y Jiang
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts
| | - Jiaman Xu
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Warren J Manning
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Boston, Massachusetts
| | - Lawrence J Markson
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Information Systems, Boston, Massachusetts
| | - Kamal R Khabbaz
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Marwa A Sabe
- Division of Cardiovascular Medicine, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Mazin I, Arad M, Freimark D, Goldenberg I, Kuperstein R. The Prognostic Role of Mitral Valve Regurgitation Severity and Left Ventricle Function in Acute Heart Failure. J Clin Med 2022; 11:jcm11154267. [PMID: 35893359 PMCID: PMC9331219 DOI: 10.3390/jcm11154267] [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: 06/12/2022] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 12/10/2022] Open
Abstract
Aims: Data about the prognostic interplay between mitral regurgitation MR and left ventricular (LV) function in the outcome of patients admitted with acute heart failure (AHF) are scarce. We evaluated the prognostic impact of MR severity and LV function on mortality and on recurrent heart failure hospitalization (re-HFH) in patients admitted with AHF. Methods and Results: In total, 6843 patients admitted with AHF were evaluated: 2521 patients with LV ejection fraction (LVEF) ≤ 40% (reduced LVEF), 1238 of them (51%) having ≥moderate MR; and 4322 with LVEF > 40% (preserved LVEF), 1175 of them (27%) having ≥moderate MR. One-year mortality and re-HFH rates were higher in patients with ≥moderate MR unrelated to the baseline LV function (p = 0.028 and p < 0.001, respectively). After multivariable analysis, only reduced LVEF, and not the severity of MR, predicted mortality risk (HR: 1.31 [95% CI: 1.12−1.53] for patients with reduced LV function and ≤mild MR; HR: 1.44 [95% CI: 1.25−1.67] for patients with reduced LV function and ≥moderate MR); p < 0.001 for both. There was an increased risk for re-HFH in each group (HR: 1.35 [95% CI: 1.17−1.52] for patients with preserved LV function and ≥moderate MR; HR: 1.31 [95% CI: 1.15−1.51] for patients with reduced LV function and mild MR; and HR: 1.65 [95% CI: 1.45−1.88] for patients with reduced LV function and ≥moderate MR); p < 0.001 for all. Conclusions: In patients admitted with AHF, the LV function is the main prognostic determinant for mortality after 1 year. Significant (≥moderate) MR is associated with an increased risk of recurrent hospitalization.
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Affiliation(s)
- Israel Mazin
- Heart Institute, Cardiology Division, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan 5365601, Israel; (M.A.); (D.F.); (R.K.)
- Correspondence: ; Tel.: +972-3-5302642; Fax: +972-3-5302191
| | - Michael Arad
- Heart Institute, Cardiology Division, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan 5365601, Israel; (M.A.); (D.F.); (R.K.)
| | - Dov Freimark
- Heart Institute, Cardiology Division, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan 5365601, Israel; (M.A.); (D.F.); (R.K.)
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Rafael Kuperstein
- Heart Institute, Cardiology Division, Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Ramat Gan 5365601, Israel; (M.A.); (D.F.); (R.K.)
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Maiello M, Zito A, Cecere A, Ciccone MM, Palmiero P. Chest pain and palpitations in postmenopausal women with mitral valve prolapse: is there a gastro-oesophageal origin? Intern Med J 2022; 52:848-852. [PMID: 33347741 DOI: 10.1111/imj.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Mitral valve prolapse (MVP) is a common disease in women, causing chest pain and palpitation due to structural and functional valve abnormality, and is sometimes associated with gastro-oesophageal reflux disease (GERD). This is a challenging clinical problem in clinical practice and requires targeted diagnostic assessment to identify the underlying causes of the symptoms, because treatment needs to be tailored, according to the causes themselves, to resolve the symptoms. AIM To assess the prevalence of GERD in a population of postmenopausal women affected by MVP and determine if there is any correlation between the two conditions. METHODS The MVP diagnosis was performed using echocardiograpy examination, according to American Society Echocardiography criteria. Two hundred and eighty-nine consecutive MVP women, symptomatic for chest pain and palpitation, were included; 250 consecutive women without MVP, symptomatic for chest pain and palpitation, were the control group (CG). The GERD diagnosis was made according to 2013 American College Gastroenterology criteria; women affected by thyroid disorders, all heart disease, including mitral disease with moderate or severe mitral regurgitation, and gastrointestinal diseases assessed using gastroscopy were excluded. RESULTS Among 289 women with MVP, 31 (11%) women were affected by GERD, and among 250 in the CG, 11 (4.4%) women were affected by GERD: Chi-squared 8.1; odds ratio 2.7; P < 0.0044. Twenty-six (9%) women affected by GERD, with MVP, presented with mild mitral regurgitation, and 7 (2.8%) women in the CG presented with mild mitral regurgitation as well: Chi-squared 8.95; odds ratio 3.4; 95% CI, P < 0.0028. DISCUSSION AND CONCLUSIONS GERD is relatively common in women with MVP. Moreover, women with MVP are approximately three times more likely to be affected by GERD; the two conditions are correlated in a statistically high significant way. GERD assessment needs to be included into routine follow-up strategies in women with MVP to optimise medical therapy, improvinge symptom relief for better quality of life.
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Affiliation(s)
- Maria Maiello
- ASL BRINDISI, Cardiology Equipe, District of Brindisi, Brindisi, Italy
| | - Annapaola Zito
- ASL BRINDISI, Cardiology Equipe, District of Francavilla Fontana, Francavilla Fontana, Italy
| | - Annagrazia Cecere
- Department of Cardiac-Thoracic-Vascular Science and Public Health, University of Padua, Padua, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Pasquale Palmiero
- ASL BRINDISI, Cardiology Equipe, District of Brindisi, Brindisi, Italy
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9
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Pagnesi M, Adamo M, Sama IE, Anker SD, Cleland JG, Dickstein K, Filippatos GS, Inciardi RM, Lang CC, Lombardi CM, Ng LL, Ponikowski P, Samani NJ, Zannad F, van Veldhuisen DJ, Voors AA, Metra M. Clinical impact of changes in mitral regurgitation severity after medical therapy optimization in heart failure. Clin Res Cardiol 2022; 111:912-923. [PMID: 35294624 PMCID: PMC9334376 DOI: 10.1007/s00392-022-01991-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Few data are available regarding changes in mitral regurgitation (MR) severity with guideline-recommended medical therapy (GRMT) in heart failure (HF). Our aim was to evaluate the evolution and impact of MR after GRMT in the Biology study to Tailored treatment in chronic heart failure (BIOSTAT-CHF). Methods A retrospective post-hoc analysis was performed on HF patients from BIOSTAT-CHF with available data on MR status at baseline and at 9-month follow-up after GRMT optimization. The primary endpoint was a composite of all-cause death or HF hospitalization. Results Among 1022 patients with data at both time-points, 462 (45.2%) had moderate-severe MR at baseline and 360 (35.2%) had it at 9-month follow-up. Regression of moderate-severe MR from baseline to 9 months occurred in 192/462 patients (41.6%) and worsening from baseline to moderate-severe MR at 9 months occurred in 90/560 patients (16.1%). The presence of moderate-severe MR at 9 months, independent from baseline severity, was associated with an increased risk of the primary endpoint (unadjusted hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.57–2.63; p < 0.001), also after adjusting for the BIOSTAT-CHF risk-prediction model (adjusted HR, 1.85; 95% CI 1.43–2.39; p < 0.001). Younger age, LVEF ≥ 50% and treatment with higher ACEi/ARB doses were associated with a lower likelihood of persistence of moderate-severe MR at 9 months, whereas older age was the only predictor of worsening MR. Conclusions Among patients with HF undergoing GRMT optimization, ACEi/ARB up-titration and HFpEF were associated with MR improvement, and the presence of moderate-severe MR after GRMT was associated with worse outcome. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-01991-7.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Iziah E Sama
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos S Filippatos
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Leong L Ng
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Faiez Zannad
- Universite de Lorraine, Inserm, Centre d'Investigations Cliniques 1433 and F-CRIN INI-CRCT, Nancy, France
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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10
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Huang H, Liu J, Bao K, Huang X, Huang D, Wei H, Remutula N, Tuersun T, Lai W, Li Q, Wang B, He Y, Yang H, Chen S, Chen J, Chen K, Tan N, Wang X, Chen L, Liu Y. Prevalence and Mortality of Moderate or Severe Mitral Regurgitation Among Patients Undergoing Percutaneous Coronary Intervention With or Without Heart Failure: Results From CIN Study With 28,358 Patients. Front Cardiovasc Med 2022; 9:796447. [PMID: 35310981 PMCID: PMC8927686 DOI: 10.3389/fcvm.2022.796447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Aim This study investigated the prevalence and mortality associated with moderate or severe mitral regurgitation (MR) among patients undergoing percutaneous coronary intervention (PCI), with or without heart failure (HF). Methods We analyzed patients undergoing PCI without mitral valve surgery from the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936). Patients without echocardiography to determine MR occurrence or lacking follow-up death data were excluded. Primary endpoints were 1-year and long-term all-cause mortality, with a median follow-up time of 5 years (interquartile range: 3.1–7.6). Results Of 28,358 patients undergoing PCI treatment [mean age: 62.7 ± 10.7; women: 6,749 (25.6%)], 3,506 (12.4%) had moderate or severe MR, and there was a higher rate of moderate or severe MR in HF group than non-HF group (28.8 vs. 5.6%, respectively). Regardless of HF conditions, patients with moderate or severe MR were older and had worse cardio-renal function and significantly increased 1-year mortality [adjusted hazard ratio (aHR): 1.82, 95% confidence interval (CI): 1.51–2.2], and long-term mortality [aHR: 1.43, 95% CI: 1.3–1.58]. There was no significant difference between patients with HF and those with non-HF (P for interaction > 0.05). Conclusion One-eighth of the patients undergoing PCI had moderate or severe MR. Furthermore, one-third and one-seventeenth experienced moderate or severe MR with worse cardiorenal function in the HF and non-HF groups, and increased consistent mortality risk. Further studies should explore the efficacy of mitral interventional procedures for moderate or severe MR after PCI treatment, regardless of HF.
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Affiliation(s)
- Haozhang Huang
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Kunming Bao
- Department of Cardiology, Longyan First Hospital Affiliated With Fujian Medical University, Longyan, China
| | - Xiaoyu Huang
- People's Hospital of Yangjiang, Yangjiang, China
| | - Dehua Huang
- People's Hospital of Yangjiang, Yangjiang, China
| | - Haiyan Wei
- Department of Cardiology, First People's Hospital of Kashgar, Kashgar, China
| | - Nuerbahaer Remutula
- Department of Cardiology, First People's Hospital of Kashgar, Kashgar, China
| | - Tilakezi Tuersun
- Department of Cardiology, First People's Hospital of Kashgar, Kashgar, China
| | - Wenguang Lai
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qiang Li
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yibo He
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Heyin Yang
- Department of Cardiology, First People's Hospital of Kashgar, Kashgar, China
| | - Shiqun Chen
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Kaihong Chen
- Department of Cardiology, Longyan First Hospital Affiliated With Fujian Medical University, Longyan, China
| | - Ning Tan
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaoyan Wang
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Xiaoyan Wang
| | - Liling Chen
- Department of Cardiology, Longyan First Hospital Affiliated With Fujian Medical University, Longyan, China
- Liling Chen
| | - Yong Liu
- Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu
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11
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Pagnesi M, Adamo M, Sama IE, Anker SD, Cleland JG, Dickstein K, Filippatos GS, Lang CC, Ng LL, Ponikowski P, Ravera A, Samani NJ, Zannad F, van Veldhuisen DJ, Voors AA, Metra M. Impact of mitral regurgitation in patients with worsening heart failure: insights from BIOSTAT-CHF. Eur J Heart Fail 2021; 23:1750-1758. [PMID: 34164895 PMCID: PMC9290728 DOI: 10.1002/ejhf.2276] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
AIMS Few data regarding the prevalence and prognostic impact of mitral regurgitation (MR) in patients with worsening chronic or new-onset acute heart failure (HF) are available. We investigated the role of MR in the BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF). METHODS AND RESULTS We performed a retrospective post-hoc analysis including patients from both the index and validation BIOSTAT-CHF cohorts with data regarding MR status. The primary endpoint was a composite of all-cause death or HF hospitalization. Among 4023 patients included, 1653 patients (41.1%) had moderate-severe MR. Compared to others, patients with moderate-severe MR were more likely to have atrial fibrillation and chronic kidney disease and had larger left ventricular (LV) dimensions, lower LV ejection fraction (LVEF), worse quality of life, and higher plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP). A primary outcome event occurred in 697 patients with, compared to 836 patients without, moderate-severe MR [Kaplan-Meier 2-year estimate: 42.2% vs. 35.3%; hazard ratio (HR) 1.28; 95% confidence interval (CI) 1.16-1.41; log-rank P < 0.0001]. The association between MR and the primary endpoint remained significant after adjusting for baseline variables and the previously validated BIOSTAT-CHF risk score (adjusted HR 1.11; 95% CI 1.00-1.23; P = 0.041). Subgroup analyses showed a numerically larger impact of MR on the primary endpoint in patients with lower LVEF, larger LV end-diastolic diameter, and higher plasma NT-proBNP. CONCLUSIONS Moderate-severe MR is common in patients with worsening chronic or new-onset acute HF and is strongly associated with outcome, independently of other features related to HF severity.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Iziah E Sama
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos S Filippatos
- Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Alice Ravera
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Faiez Zannad
- Universite de Lorraine, Inserm, Centre d'Investigations Cliniques 1433 and F-CRIN INI-CRCT, Nancy, France
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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12
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Arora S, Sivaraj K, Hendrickson M, Chang PP, Weickert T, Qamar A, Vaduganathan M, Caughey MC, Pandey A, Cavender MA, Rosamond W, Vavalle JP. Prevalence and Prognostic Significance of Mitral Regurgitation in Acute Decompensated Heart Failure: The ARIC Study. JACC. HEART FAILURE 2021; 9:179-189. [PMID: 33309575 PMCID: PMC8075289 DOI: 10.1016/j.jchf.2020.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study investigates the prevalence and prognostic significance of mitral regurgitation (MR) in acute decompensated heart failure (ADHF) patients. BACKGROUND Few studies characterize the burden of MR in heart failure. METHODS The ARIC (Atherosclerosis Risk In Communities) study surveilled ADHF hospitalizations for residents ≥55 years of age in 4 U.S. communities. ADHF cases were stratified by left ventricular ejection fraction (LVEF): <50% and ≥50%. Odds of moderate or severe MR in patients with varying sex and race, and odds of 1-year mortality in those with higher MR severity were estimated using multivariable logistic regression. RESULTS From 2005 to 2014, there were 17,931 weighted ADHF hospitalizations of which 49.2% had an LVEF <50% and 50.8% an LVEF ≥50%. Moderate or severe MR prevalence was 44.5% in those with an LVEF <50% and 27.5% in those with an LVEF ≥50%. Moderate or severe MR was more likely in females than males regardless of LVEF; LVEF <50% (odds ratio [OR]: 1.21 [95% confidence interval (CI): 1.11 to 1.33]), LVEF ≥50% (OR: 1.52 [95% CI: 1.36 to 1.69]). Among hospitalizations with an LVEF ≥50%, moderate or severe MR was less likely in blacks than whites (OR: 0.72 [95% CI: 0.64 to 0.82]). Higher MR severity was independently associated with increased 1-year mortality in those with an LVEF <50% (OR: 1.30 [95% CI: 1.16 to 1.45]). CONCLUSIONS Patients with ADHF have a significant MR burden that varies with sex and race. In ADHF patients with an LVEF <50%, higher MR severity is associated with excess 1-year mortality.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Krishan Sivaraj
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Hendrickson
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Patricia P Chang
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Thelsa Weickert
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Arman Qamar
- NorthShore Cardiovascular Institute, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew A Cavender
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wayne Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John P Vavalle
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
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13
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The Potential Role of Transcatheter Heart Valve Interventions in Heart Failure Treatment. JACC Cardiovasc Interv 2019; 12:166-168. [PMID: 30594512 DOI: 10.1016/j.jcin.2018.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 01/14/2023]
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14
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Rieth A, Richter MJ, Gall H, Seeger W, Ghofrani HA, Mitrovic V, Hamm CW. Hemodynamic phenotyping based on exercise catheterization predicts outcome in patients with heart failure and reduced ejection fraction. J Heart Lung Transplant 2017; 36:880-889. [DOI: 10.1016/j.healun.2017.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 12/31/2022] Open
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15
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Santas E, Núñez E, Núñez J. Role of functional mitral regurgitation in heart failure with preserved ejection fraction: an unrecognized protagonist? Eur J Heart Fail 2017; 19:290. [PMID: 27647481 DOI: 10.1002/ejhf.653] [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: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Blasco Ibanez 17, 46010, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
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16
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Hamm K, Zacher M, Hautmann M, Gietzen F, Halbfass P, Kerber S, Diegeler A, Schieffer B, Barth S. Influence of experience on procedure steps, safety, and functional results in edge to edge mitral valve repair-a single center study. Catheter Cardiovasc Interv 2016; 90:313-320. [DOI: 10.1002/ccd.26806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/05/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Karsten Hamm
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Michael Zacher
- Department of Cardiac Surgery; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Martina Hautmann
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Frank Gietzen
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Philipp Halbfass
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Sebastian Kerber
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Anno Diegeler
- Department of Cardiac Surgery; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
| | - Bernhard Schieffer
- Department of Cardiology; Phillipp University of Marburg; Marburg Germany
| | - Sebastian Barth
- Department of Cardiology; Cardiovascular Center Bad Neustadt; Bad Neustadt Germany
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17
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Cho JS, Youn HJ, Her SH, Park MW, Kim CJ, Park GM, Jeong MH, Cho JY, Ahn Y, Kim KH, Park JC, Seung KB, Cho MC, Kim CJ, Kim YJ, Han KR, Kim HS. The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction. J Korean Med Sci 2015; 30:903-10. [PMID: 26130953 PMCID: PMC4479944 DOI: 10.3346/jkms.2015.30.7.903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 04/01/2015] [Indexed: 11/20/2022] Open
Abstract
The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.
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Affiliation(s)
- Jung Sun Cho
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ho Her
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Maen Won Park
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Joon Kim
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Gyung-Min Park
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myung Ho Jeong
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jae Yeong Cho
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Youngkeun Ahn
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Kye Hun Kim
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Jong Chun Park
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Ki Bae Seung
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myeong Chan Cho
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
| | - Chong Jin Kim
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
| | - Young Jo Kim
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
| | - Kyoo Rok Han
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
| | - Hyo Soo Kim
- Korea Acute Myocardial Infarction Registry Investigators of Korean Circulation Society, Seoul, Korea
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18
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Borisenko O, Haude M, Hoppe UC, Siminiak T, Lipiecki J, Goldberg SL, Mehta N, Bouknight OV, Bjessmo S, Reuter DG. Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings. BMC Cardiovasc Disord 2015; 15:43. [PMID: 25971307 PMCID: PMC4443594 DOI: 10.1186/s12872-015-0039-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the cost-effectiveness of the percutaneous mitral valve repair (PMVR) using Carillon® Mitral Contour System® (Cardiac Dimensions Inc., Kirkland, WA, USA) in patients with congestive heart failure accompanied by moderate to severe functional mitral regurgitation (FMR) compared to the prolongation of optimal medical treatment (OMT). METHODS Cost-utility analysis using a combination of a decision tree and Markov process was performed. The clinical effectiveness was determined based on the results of the Transcatheter Implantation of Carillon Mitral Annuloplasty Device (TITAN) trial. The mean age of the target population was 62 years, 77% of the patients were males, 64% of the patients had severe FMR and all patients had New York Heart Association functional class III. The epidemiological, cost and utility data were derived from the literature. The analysis was performed from the German statutory health insurance perspective over 10-year time horizon. RESULTS Over 10 years, the total cost was €36,785 in the PMVR arm and €18,944 in the OMT arm. However, PMVR provided additional benefits to patients with an 1.15 incremental quality-adjusted life years (QALY) and an 1.41 incremental life years. The percutaneous procedure was cost-effective in comparison to OMT with an incremental cost-effectiveness ratio of €15,533/QALY. Results were robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis with a willingness-to-pay threshold of €35,000/QALY, PMVR had a 84 % probability of being cost-effective. CONCLUSIONS Percutaneous mitral valve repair may be cost-effective in inoperable patients with FMR due to heart failure.
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Affiliation(s)
| | - Michael Haude
- Medical Clinic I, Neuss City Clinic, Lukas Krankenhaus GmbH, Preußenstraße 84, 41464, Neuss, Germany.
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Müllner Hauptstr. 48, A-5020, Salzburg, Austria.
| | - Tomasz Siminiak
- Department of Cardiology, Interventional Cardiology, HCP Medical Center, Poznan University of Medical Sciences, ul. 28 czerwca 1956 Nr 194, 61-485, Poznan, Poland.
| | - Janusz Lipiecki
- Pole Sante Republique, 105 Avenue de la République, 63050, Clermont-Ferrand, France.
| | - Steve L Goldberg
- Department of Cardiology, University of Washington, Seattle, WA, USA.
| | - Nawzer Mehta
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Omari V Bouknight
- Cardiac Dimensions Incorporated, 5540 Lake Washington Blvd NE, Kirkland, WA, 98033, USA.
| | - Staffan Bjessmo
- Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden. .,Department of Learning Informatics, Medical Management Centre, Management and Ethics, Karolinska Institutet, Solnavägen 1, 171 77, Solna, Sweden.
| | - David G Reuter
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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19
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Slope in preload recruitable stroke work relationship predicts survival after left ventriculoplasty and mitral repair in patients with idiopathic cardiomyopathy. J Cardiol 2015; 65:157-63. [DOI: 10.1016/j.jjcc.2014.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022]
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20
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Trochu JN, Dillon R, Gustafsson F, Mitchell SA, Mitrovic V, Alfieri O. Mitral regurgitation - Unmet need for improved management strategies. IJC HEART & VASCULATURE 2014; 5:26-41. [PMID: 28785609 PMCID: PMC5497153 DOI: 10.1016/j.ijcha.2014.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/26/2014] [Indexed: 11/18/2022]
Abstract
Background The management of mitral regurgitation (MR) is challenging — patients may be asymptomatic, oligosymptomatic, older with comorbidities, or clinically symptomatic and not appropriate for surgery. The current review assesses morbidity, mortality, and risk factors associated with functional and organic MR, with a focus on severe MR. Methods A structured literature review was conducted in MEDLINE, Embase, the Cochrane Library, and via hand-searching of conference proceedings. Prospective randomised controlled trials and observational studies including adult patients with MR reporting on treatment response rates, survival, time-to-treatment failure, quality of life, and adverse events were eligible for inclusion. Results In total, 32 publications met the inclusion criteria (9 in functional, 18 in organic, and 5 in functional/organic). Despite study heterogeneity, an increased risk of mortality and morbidity was observed which increased with MR severity. Risk factors associated with mortality and morbidity included advancing age, presence of atrial fibrillation, increasing effective regurgitant orifice, ejection fraction, left ventricle end systolic diameter, diabetes, and increasing New York Heart Association class. Conclusions The current review represents one of the most comprehensive conducted in the medical/conservative management of MR. An increased risk of mortality and morbidity, which appeared to rise with greater severity, was associated with MR (versus no MR). An unmet need exists in the management of patients with severe symptomatic MR and a high surgical risk as they have a poor prognosis and limited treatment options. Further research into alternative medical strategies and patient management is needed to improve prognoses and reduce mortality and morbidity.
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Affiliation(s)
| | | | - Finn Gustafsson
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Hospital, Milano, Italy
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21
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Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. Heart Fail Rev 2014; 20:305-16. [DOI: 10.1007/s10741-014-9461-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Schillinger W, Athanasiou T, Weicken N, Berg L, Tichelbäcker T, Puls M, Hünlich M, Wachter R, Helms HJ, Seipelt R, Schöndube FA, Hasenfuss G. Impact of the learning curve on outcomes after percutaneous mitral valve repair with MitraClip®
and lessons learned after the first 75 consecutive patients. Eur J Heart Fail 2014; 13:1331-9. [DOI: 10.1093/eurjhf/hfr141] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wolfgang Schillinger
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Thomas Athanasiou
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Ninja Weicken
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Lars Berg
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Tobias Tichelbäcker
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Miriam Puls
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Mark Hünlich
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Rolf Wachter
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
| | - Hans-Joachim Helms
- Medizinische Statistik; Universitätsmedizin Göttingen; Göttingen Germany
| | - Ralf Seipelt
- Universitätsmedizin Göttingen, Herzzentrum, Abt. Thorax-, Herz- und Gefäßchirurgie; Göttingen Germany
| | - Friedrich A. Schöndube
- Universitätsmedizin Göttingen, Herzzentrum, Abt. Thorax-, Herz- und Gefäßchirurgie; Göttingen Germany
| | - Gerd Hasenfuss
- Abt. Kardiologie und Pneumologie; Universitätsmedizin Göttingen, Herzzentrum; Robert-Koch-Str. 40, D-37099 Göttingen Germany
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Castelli G, Fornaro A, Ciaccheri M, Dolara A, Troiani V, Tomberli B, Olivotto I, Gensini GF. Improving Survival Rates of Patients With Idiopathic Dilated Cardiomyopathy in Tuscany Over 3 Decades. Circ Heart Fail 2013; 6:913-21. [DOI: 10.1161/circheartfailure.112.000120] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Gabriele Castelli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alessandra Fornaro
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Mauro Ciaccheri
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Alberto Dolara
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Vito Troiani
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Benedetta Tomberli
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Gian Franco Gensini
- From the Heart and Vessel Department, Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
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Rudolph V, Lubos E, Schlüter M, Lubs D, Goldmann B, Knap M, de Vries T, Treede H, Schirmer J, Conradi L, Wegscheider K, Reichenspurner H, Blankenberg S, Baldus S. Aetiology of mitral regurgitation differentially affects 2-year adverse outcomes after MitraClip therapy in high-risk patients. Eur J Heart Fail 2013; 15:796-807. [PMID: 23426023 DOI: 10.1093/eurjhf/hft021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess, and identify predictors of 2-year adverse outcomes of surgical high-risk patients after successful MitraClip therapy (MC), differentiated by the aetiology of mitral regurgitation (MR). METHODS AND RESULTS Kaplan-Meier analysis was used to assess survival free from death, heart failure rehospitalization, and reintervention up to 2 years in 202 successfully treated patients [74 ± 9 years, 132 men (65%); secondary MR aetiology in 140 patients, primary MR in 62]. Predictors for study endpoints were determined using Cox regression analyses. Mortality was 20% at 1 year and 33% at 2 years in both primary and secondary MR patients; independent predictors of death were reduced forward stroke volume, impaired LV function, and renal failure in primary MR, yet only an increased logistic EuroSCORE in functional MR patients. The rate of rehospitalizations was not different between the patient subgroups for 6 months, but then diverged significantly in favour of primary MR patients (estimated 2-year incidence, primary MR 40% vs. secondary MR 66%). No predictor was found for primary MR patients, but increased LV end-diastolic volume significantly increased the risk of rehospitalization in functional MR patients. Reinterventions were overall rare (7.4% at 1 year, 9.7% at 2 years); primary MR patients required all except one reintervention within 2 months of MC, with again no predictors found, whereas secondary MR patients (all except one with discharge MR of 2+) exhibited a steadily declining freedom from reintervention curve throughout follow-up. CONCLUSION MR aetiology affects rehospitalization and reintervention, but not mortality, differently after successful MC.
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Affiliation(s)
- Volker Rudolph
- Department of General and Interventional Cardiology, University Heart Centre, Cologne, Germany.
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Abstract
Mitral regurgitation (MR) is a common complication in heart failure patients, severely worsening their outcome. Because of the high perioperative risk, mitral valve surgery, which is the standard therapy for MR, is often not offered to these patients. Interventional therapies for mitral valve therapy might therefore constitute a novel therapeutic option particularly in this group. This article gives an overview of the available and evolving interventional strategies for mitral valve repair with a special emphasis on heart failure patients.
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