TY - JOUR
T1 - Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair
T2 - North American Mitraclip for Functional Mitral Regurgitation Registry
AU - Duggal, Neal M.
AU - Engoren, Milo
AU - Chadderdon, Scott M.
AU - Rodriguez, Evelio
AU - Morse, M. Andrew
AU - Vannan, Mani A.
AU - Yadav, Pradeep K.
AU - Morcos, Michael
AU - Li, Flora
AU - Reisman, Mark
AU - Garcia-Sayan, Enrique
AU - Raghunathan, Deepa
AU - Sodhi, Nishtha
AU - Sorajja, Paul
AU - Chen, Lily
AU - Rogers, Jason H.
AU - Calfon, Marcella A.
AU - Kovach, Christopher P.
AU - Gill, Edward A.
AU - Zahr, Firas E.
AU - Chetcuti, Stanley J.
AU - Yuan, Yuan
AU - Mentz, Graciela B.
AU - Lim, D. Scott
AU - Ailawadi, Gorav
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2024/2/15
Y1 - 2024/2/15
N2 - The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
AB - The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
KW - functional mitral regurgitation
KW - mitral transcatheter edge-to-edge repair
KW - proportionality
KW - regurgitant orifice
UR - http://www.scopus.com/inward/record.url?scp=85181879229&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85181879229&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2023.12.020
DO - 10.1016/j.amjcard.2023.12.020
M3 - Article
C2 - 38110022
AN - SCOPUS:85181879229
SN - 0002-9149
VL - 213
SP - 99
EP - 105
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -