Diabetes Mellitus in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair-A Decade Experience in 1000+ Patients

Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair

Aim

Diabetes mellitus (DM) represents a notable risk factor within surgical and interventional procedures. Data on its influence on survival after Transcatheter Edge-to-Edge Repair (TEER) of Mitral valve Regurgitation (MR) are sparse.

Methods

In a retrospective monocentric assessment after successful treatment of MR using TEER from 06/2010 to 03/2018 patients were stratified for DM. Mortality was analyzed during follow-up using Cox regression analyses.

Results

Of 627 patients (47.0 % females, 88.2 % aged ≥ 70 years, median follow-up 486 days) consecutively included, subjects with DM (N = 174, 27.8 %) had a higher prevalence of comorbidities like obesity (27.3 % vs. 9.2 %, p < 0.001), arterial hypertension (91.4 % vs. 83.7 %, p = 0.013), renal insufficiency (63.8 % vs. 43.9 %, p < 0.001), coronary artery disease (77.0 % vs. 59.8 %, p < 0.001) and peripheral artery disease (14.4 % vs. 8.4 %, p = 0.026). Patients with DM presented with higher median logistic Euroscore I (29.4 % [20.0/43.0] vs. 25.0 % [16.7/36.6], p = 0.001) and more severely reduced systolic function (LVEF 35 % [30/50] vs. 45 % [30/55], p < 0.001). No difference in short- and long-term survival was detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6 %, p = 0.771; at 30-days 5.0 vs. 6.0 %, p = 0.842, 1-year 28.7 vs. 25.0 %, p = 0.419, 3-years 49.2 vs. 44.1 %, p = 0.554, 5-years 69.0 vs. 68.3 %, p = 0.497). The presence of DM was not attributed as an individual risk factor for elevated mortality (HR 1-year 1.17 [95 % CI 0.80-1.71], p = 0.419; HR long-term 1.13 [95 %CI 0.86-1.49], p = 0.373).

Conclusion

Although linked to a more vulnerable clinical profile and despite being factored in common risk factor models, DM was not associated with an elevated short- and long-term mortality after TEER of MR.

The Impact of Preprocedural Blood Pressure on Outcome After M-TEER: The Paradox or Something Else?

OBJECTIVE

The aim of this study was to investigate the influence of systolic blood pressure (SBP) values on admission on the outcome of mitral transcatheter edge-to-edge repair (M-TEER).

METHODOLOGY

We included all patients who underwent interventional MV repair in our institution between January 2010 and October 2020. All data are obtained from the MiTra ULM registry. Based on SBP values measured on admission, all patients were divided into four groups: < 120, 120-129, 130-139, and ≥ 140 mmHg.

RESULTS

Eight hundred and fifty-eight patients were included in this study. There were no major differences in demographic and clinical characteristics between the four observed groups. The patients with SBP on admission ≥ 140 mmHg had the lowest prevalence of functional MR and the highest LVEF. Higher SBP at admission (HR 0.74, 95% CI: 0.63-0.87) and preprocedural LVEF values (HR 0.99, 95% CI: 0.97-0.99) were predictors of lower 1-year mortality but did not impact 1-year hospitalization rate or MACE in the whole study population. When patients were separated into two groups according to the mechanisms of MR (functional and structural), the results showed that higher SBP on admission and better preprocedural LVEF were associated with significantly lower 1-year CV mortality in both groups of patients, with functional and structural MR. Higher SBP at admission was also associated with lower 1-year CV mortality (HR 0.73, 95% CI: 0.55-0.96) in patients with preserved ejection fraction (LVEF > 50%), but not with 1-year rehospitalization and MACE.

CONCLUSION

Higher SBP on admission (> 140 mmHg) is an independent predictor of a better 1-year outcome in patients treated with M-TEER. The effect of higher SBP on outcome after M-TEER should be further investigated.

Prevalence and impact of diabetes in patients with valvular heart disease

This study aimed to investigate the prevalence of diabetes in valvular heart disease (VHD), as well as the relationship of diabetes with severity of valvular lesions and clinical outcome. A total of 11,862 patients with significant (≥moderate) VHD from the China Valvular Heart Disease study were included in the analysis. The primary outcome was the composite of all-cause death, hospitalization for heart failure, and myocardial infarction during two-year follow-up. The prevalence of diabetes was 14.5% (1,721/11,862) in VHD. After adjusting for patients' demographics, diabetes was associated with a significantly lower risk of severe valvular lesion in aortic regurgitation and mitral regurgitation (MR). In multivariable analysis, diabetes was identified as an independent predictor of two-year outcome in patients with MR (hazard ratio: 1.345, 95% confidence interval: 1.069-1.692, p = 0.011). More efforts should be made to enhance our understanding and improve outcomes of concomitant VHD and diabetes.