Details

Autor(en) / Beteiligte

• Debonnaire, Philippe
• Heyning, Caroline M. Van De
• Haddad, Milad El
• Coussement, Patrick
• Paelinck, Bernard
• de Ceuninck, Michel
• Timmermans, Frank
• De Bock, Dina
• Drieghe, Benny
• Dujardin, Karl
• Vandekerckhove, Yves
• Kedhi, Elvin
• Claeys, Marc
• Van der Heyden, Jan

Titel

Left Ventricular End-Systolic Dimension and Outcome in Patients With Heart Failure Undergoing Percutaneous MitraClip Valve Repair for Secondary Mitral Regurgitation

Ist Teil von

• The American journal of cardiology, 2020-07, Vol.126, p.56-65

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

Access via ScienceDirect (Elsevier)

Beschreibungen/Notizen

• In heart failure patients with significant secondary mitral regurgitation:•Left ventricular end systolic dimension (LVESD) may define baseline LV remodeling.•Higher LVESD (advanced remodeling) does not affect MitraClip safety nor efficacy.•Higher LVESD (advanced remodeling) does not affect MitraClip symptomatic response.•Higher LVESD (advanced remodeling) attenuates prognostic benefit of MitraClip.•LVESD may be a valuable parameter for heart failure MitraClip patient selection. Recent MitraClip heart failure (HF) trials suggest that baseline left ventricular (LV) remodeling may be critical for patient selection. We, therefore, investigated whether baseline LV remodeling affects safety, efficacy, and clinical outcomes in HF patients with symptomatic secondary mitral regurgitation (MR) undergoing percutaneous mitral valve repair using MitraClip. LV remodeling was assessed by LV end-systolic dimension index (LVESDi) on transthoracic baseline echocardiography. Early and late outcome was reported using Mitral Valve Academic Research Consortium-criteria. A total of 107 consecutive HF patients (73 ± 10 years, 70% male) who underwent MitraClip intervention for secondary MR were studied. The study population was stratified by median LVESDi between nonadvanced (<28 mm/m², n = 49) and advanced LV remodeling (≥28 mm/m², n = 58). Both groups had similar acute procedural success, in hospital bleeding and nonbleeding complications and significant improvement in MR severity and symptoms, sustained up to 36 months (all p >0.05). LVESDi, but not LV end-diastolic diameter index nor LV ejection fraction, independently related to HF hospitalization (hazard ratio 1.11, 95% confidence interval 1.05 to 1.16, p <0.001) and mortality (hazard ratio 1.11, 95% confidence interval 1.06 to 1.17, p <0.001). At 1 and 3 years, survival free of HF hospitalization was higher in patients without versus with advanced LV remodeling (89% vs 66% and 65% vs 37%, p = 0.002) and mortality was lower (9% vs 24% and 36% vs 47%, p = 0.074), respectively. Annual HF hospitalization rate only decreased in the nonadvanced LV remodeling group (−43%, p = 0.025). Advanced LV remodeling, assessed by LVESDi, in HF patients who underwent MitraClip therapy does not influence therapeutic safety nor efficacy, but implies increased HF hospitalization and mortality risk. This parameter may be valuable for MitraClip therapy patient selection.