1
|
Shechter A, Patel V, Kaewkes D, Lee M, Hong GJ, Koren O, Chakravarty T, Koseki K, Nagasaka T, Skaf S, Makar M, Makkar RR, Siegel RJ. Preprocedural transthoracic echocardiography for predicting outcomes of transcatheter edge-to-edge repair for chronic primary mitral regurgitation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00345-6. [PMID: 38142937 DOI: 10.1016/j.rec.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES Limited data exist on the prognostic usefulness of transthoracic echocardiography preceding MitraClip for chronic primary mitral regurgitation (MR). We evaluated the predictive ability of transthoracic echocardiography in this setting. METHODS A total of 410 patients (median age, 83 years, 60.7% males) were included in the study. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalization. Secondary endpoints encompassed individual elements of the primary outcome, the persistence of significant functional impairment or above-moderate MR at 1 year, and above-mild MR at 1-month. RESULTS Left ventricular end-systolic diameter index of ≥ 2.1cm/m2, corresponding to the cohort's 4th quartile (HR, 2.44; 95%CI, 1.09-4.68; P=.022). Concurrently, higher left atrial volume index (LAVi) and a mid-diastolic medial-lateral mitral annular diameter (MAD) equal to or above the cohort's median of 32.2mm were linked to a higher probability of death and heart failure hospitalization, respectively. LAVi of ≥ 60mL/m2, above-mild mitral annular calcification, and above-moderate tricuspid regurgitation conferred higher odds of functional class III-IV or above-moderate MR persistence. All variables except LAVi and MAD, as well as indexed mid-diastolic medial-lateral MAD of ≥ 20.2mm/m2 and mitral effective regurgitant orifice area of ≥ 0.40 cm2, were associated with greater-than-mild MR at 1 month. CONCLUSIONS Preprocedural increased indexed left heart dimensions, mainly left ventricular end-systolic diameter index, MAD, mitral annular calcification, mitral effective regurgitant orifice area, and tricuspid regurgitation mark a less favorable course post-MitraClip for chronic primary MR.
Collapse
Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Mirae Lee
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Gloria J Hong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States.
| |
Collapse
|
2
|
Kathavarayan Ramu S, Agrawal A, Shekhar S, Bansal A, Isogai T, Yun J, Reed GW, Puri R, Krishnaswamy A, Kapadia SR. MitraCox Score Predicts In-Hospital Mortality in Patients Admitted for Transcatheter Edge-to-Edge Mitral Valve Repair. Am J Cardiol 2023; 207:39-47. [PMID: 37722200 DOI: 10.1016/j.amjcard.2023.08.160] [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: 07/03/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
As mitral valve transcatheter edge-to-edge repair (M-TEER) is evolving as an effective treatment for high-risk surgical patients with mitral regurgitation, there is a pressing need for cardiologists to optimize resources through risk stratification of in-hospital mortality for this patient population. Although current risk-prediction models have been shown to predict adverse outcomes with reasonable accuracy, models trained using the US nationwide population are lacking. This study aimed to identify clinical, demographic, and procedural features that predict in-hospital mortality, and to derive and validate an in-hospital mortality risk-prediction tool in patients who have undergone M-TEER. A total of 9,373 admissions from the Nationwide Readmissions Database of patients who underwent M-TEER between 2015 and 2018 were used to develop and validate the model. We first performed least absolute shrinkage and selection operator (LASSO) regularization of Cox regression (Coxnet) that is 10-fold cross-validated. The non-zero coefficients were multiplied with the respective values of each observation of the predictors to build the scoring formula. Out of 9,373 admissions, 196 patients (2%) died in-hospital during index admission. In descending order, the top variables that were most predictive of in-hospital mortality were higher age, presence of fluid and electrolyte disturbance, and large metropolitan location of the hospital. The validation C-statistic of the MitraCox score was 0.82. Using X-tile software (Yale School of Medicine, New Haven, Connecticut), 2 cutoffs of the score were determined on the basis of in-hospital mortality and length of stay, and the survival of the population was classified into 3 risk groups: low, intermediate, and high. The scoring system deployed online as a web-based calculator can be accessed at https://kathavs.shinyapps.io/Mitracox_Kapadia/. In conclusion, MitraCox score is easy to calculate and predicts in-hospital mortality depending on length of stay in a dynamic manner.
Collapse
Affiliation(s)
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Agam Bansal
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
3
|
FENG DJ, YE YQ, LI Z, ZHANG B, LIU QR, WANG WW, ZHAO ZY, ZHOU Z, ZHAO QH, YU ZK, ZHANG HT, DUAN ZY, WANG BC, LV JX, GUO S, GAO RL, XU HY, WU YJ. Development and validation of a score predicting mortality for older patients with mitral regurgitation. J Geriatr Cardiol 2023; 20:577-585. [PMID: 37675263 PMCID: PMC10477587 DOI: 10.26599/1671-5411.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To develop and validate a user-friendly risk score for older mitral regurgitation (MR) patients, referred to as the Elder-MR score. METHODS The China Senile Valvular Heart Disease (China-DVD) Cohort Study functioned as the development cohort, while the China Valvular Heart Disease (China-VHD) Study was employed for external validation. We included patients aged 60 years and above receiving medical treatment for moderate or severe MR (2274 patients in the development cohort and 1929 patients in the validation cohort). Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion. RESULTS Eight predictors were identified: age ≥ 75 years, body mass index < 20 kg/m2, NYHA class III/IV, secondary MR, anemia, estimated glomerular filtration rate < 60 mL/min per 1.73 m2, albumin < 35 g/L, and left ventricular ejection fraction < 60%. The model displayed satisfactory performance in predicting one-year mortality in both the development cohort (C-statistic = 0.73, 95% CI: 0.69-0.77, Brier score = 0.06) and the validation cohort (C-statistic = 0.73, 95% CI: 0.68-0.78, Brier score = 0.06). The Elder-MR score ranges from 0 to 15 points. At a one-year follow-up, each point increase in the Elder-MR score represents a 1.27-fold risk of death (HR = 1.27, 95% CI: 1.21-1.34, P < 0.001) in the development cohort and a 1.24-fold risk of death (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001) in the validation cohort. Compared to EuroSCORE II, the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort (C-statistic = 0.71 vs. 0.70, net reclassification improvement = 0.320, P < 0.01; integrated discrimination improvement = 0.029, P < 0.01). CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.
Collapse
Affiliation(s)
- De-Jing FENG
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yun-Qing YE
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhe LI
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin ZHANG
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Rong LIU
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wei-Wei WANG
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhen-Yan ZHAO
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zheng ZHOU
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Hao ZHAO
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zi-Kai YU
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hai-Tong ZHANG
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhen-Ya DUAN
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin-Cheng WANG
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun-Xing LV
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shuai GUO
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Run-Lin GAO
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hai-Yan XU
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yong-Jian WU
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Scotti A, Latib A, Rubbio AP, Testa L, Adamo M, Denti P, Melillo F, Taramasso M, Sisinni A, De Marco F, Grasso C, Giordano A, Bartorelli AL, Buzzatti N, Citro R, De Felice F, Indolfi C, Monteforte I, Villa E, Giannini C, Petronio AS, Crimi G, Tarantini G, Colombo A, Agricola E, Metra M, Zangrillo A, Margonato A, Tamburino C, Maisano F, Bedogni F, Godino C. Derivation and Validation of a Clinical Risk Score for COAPT-Ineligible Patients Who Underwent Transcatheter Edge-to-Edge Repair. Am J Cardiol 2023; 186:100-108. [PMID: 36356428 DOI: 10.1016/j.amjcard.2022.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
Up to half of real-world patients with secondary mitral regurgitation who underwent transcatheter edge-to-edge repair (TEER) do not meet the highly selective COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) criteria. No randomized trials or standardized and validated tools exist to evaluate the risk: benefit ratio of TEER in this specific population. We sought to derive and externally validate a clinical risk score to predict the risk of death or heart failure (HF) hospitalization for COAPT-ineligible patients who underwent TEER (CITE score). The study population consisted of patients with secondary mitral regurgitation having at least 1 exclusion criterion of the COAPT trial. The derivation cohort included 489 patients from the GIOTTO (GIse registry of Transcatheter treatment of Mitral Valve regurgitaTiOn) registry. Cox proportional hazards regression was used to identify predictors of 2-year death/HF hospitalization and develop a numerical risk score. The predictive performance was assessed in the derivation cohort and validated in 268 patients from the MiZüBr (Milan-Zürich-Brescia) registry. The CITE score (hemodynamic instability, left ventricular impairment, New York Heart Association class III/IV, peripheral artery disease, atrial fibrillation, brain natriuretic peptide, and hemoglobin) showed a c-index for 2-year death or HF hospitalization of 0.70 (95% confidence interval [CI] 0.67 to 0.73) in the derivation cohort, and 0.68 (95% CI 0.64 to 0.73) in the validation cohort. A cutoff of <12 points was selected to identify patients at lower risk of adverse outcomes, hazard ratio of 0.35 (95% CI 0.26 to 0.46). In conclusion, the CITE score is a simple 7-item tool for the prediction of death or HF hospitalization at 2 years after TEER in COAPT-ineligible patients. The score may support clinical decision-making by identifying those patients who, even if excluded from clinical trials, can still benefit from TEER.
Collapse
Affiliation(s)
- Andrea Scotti
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Azeem Latib
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Denti
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Taramasso
- Division of Cardiothoracic Surgery, Arzt bei Herzzentrum Hirslanden Zürich, Zürich, Switzerland
| | - Antonio Sisinni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castelvolturno, Italy
| | - Antonio L Bartorelli
- Interventional Cardiology, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | - Nicola Buzzatti
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Rodolfo Citro
- Cardio-Thorax-Vascular Department, A.O.U. San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy; Interventional Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed. Pozzilli, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | - Ciro Indolfi
- Division of Cardiology, University Magna Graecia, Catanzaro, Italy
| | - Ida Monteforte
- Interventional Cardiology, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit Poliambulanza Hospital, Fondazione Poliambulanza Brescia Italy
| | - Cristina Giannini
- Cardiothoracic and Vascular Department, Cardiac Catheterization Laboratory, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, Cardiac Catheterization Laboratory, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Antonio Colombo
- Interventional Cardiology, Humanitas Clinical and Research Center Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) - Rozzano, Milan, Italy
| | - Eustachio Agricola
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory, Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Zangrillo
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Margonato
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, Heart Valve Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
5
|
Iliadis C, Kavsur R, Spieker M, Zachoval C, Becher MU, Westenfeld R, Pfister R. Therapie der sekundären Mitralklappeninsuffizienz – Strategien eines interuniversitären Verbundes. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1912-4962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungDie sekundäre Mitralinsuffizienz ist bei Patienten mit Herzinsuffizienz häufig und mit einem schlechten Verlauf assoziiert. Aufgrund des hohen OP-Risikos war die Therapie traditionell auf
eine Behandlung der Herzinsuffizienz beschränkt. Die Entwicklung von kathetergestützten Techniken ermöglicht nun die Behandlung mit geringem Risiko. Wenngleich die Studienevidenz immer noch
begrenzt ist, erfolgte in den aktuellen Leitlinien der europäischen Fachgesellschaften eine Aufwertung der kathetergestützten Therapie für ausgewählte Patienten mit hohem OP-Risiko und hoher
Wahrscheinlichkeit für ein Therapieansprechen. Dennoch bleiben viele Fragen offen, was die Rolle der chirurgischen Behandlung und auch die Patientenselektion für kathetergestützte
Therapieverfahren angeht. Hier beschreiben wir den aktuellen Stand der Behandlung der sekundären Mitralinsuffizienz und zeigen Strategien von transuniversitären Verbundprojekten mit dem
Ziel, Evidenz für die Behandlung dieser Patienten zu entwickeln.
Collapse
Affiliation(s)
- Christos Iliadis
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
| | - Refik Kavsur
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Maximilian Spieker
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Christian Zachoval
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Marc Ulrich Becher
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Ralf Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Roman Pfister
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
| |
Collapse
|
6
|
Gill H, Adams HSL, Chehab O, Allen C, Hancock J, Lamata P, Lucchese G, Prendergast B, Redwood S, Patterson T, Rajani R. Anatomy of a Transcatheter Mitral Valve Service. Front Cardiovasc Med 2022; 9:862471. [PMID: 35497993 PMCID: PMC9051038 DOI: 10.3389/fcvm.2022.862471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Transcatheter mitral therapies offer treatment options to selected patients who are unable to undergo open procedures due to prohibitive surgical risk. Data detailing the design and structure of transcatheter mitral services to ensure appropriate patient selection and tailored management strategies is lacking. We report our initial experience of developing and running a purpose-built transcatheter mitral service. The nature and number of referral sources, the multi-disciplinary make-up of the dedicated Mitral Heart Team and the use of integrative imaging assessment with incorporation of computational solutions are discussed. In addition, a summary of the clinical decision-making process is presented. This report sets out a framework from which future clinics can evolve to improve and streamline the delivery of transcatheter mitral therapies.
Collapse
Affiliation(s)
- Harminder Gill
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Heath S. L. Adams
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Omar Chehab
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Christopher Allen
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Jane Hancock
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| | - Gianluca Lucchese
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Simon Redwood
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Tiffany Patterson
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ronak Rajani
- Cardiovascuar Directorate, Guy's and St Thomas' Hospitals, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences Engineering, King's College London, London, United Kingdom
| |
Collapse
|
7
|
Kavsur R, Spieker M, Iliadis C, Metze C, Transier M, Tiyerili V, Horn P, Baldus S, Kelm M, Nickenig G, Westenfeld R, Pfister R, Becher MU. Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Am Heart Assoc 2021; 10:e019548. [PMID: 34187184 PMCID: PMC8403297 DOI: 10.1161/jaha.120.019548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user-friendly mortality risk stratification tool that is validated on a large-scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0-7), intermediate (8-9), and a high (10-12) MIDA score group. MR was assessed in follow-up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2-year follow-up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log-rank test P<0.001). Hazard of all-cause mortality increased by 13% (95% CI, 3%-25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log-rank test P=0.001). Frequency of residual MR ≥II at follow-up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P<0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event-free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.
Collapse
Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Moritz Transier
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Georg Nickenig
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | | |
Collapse
|