Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair

Abstract

Percutaneous mitral valve repair has been increasingly performed worldwide after approval. We sought to investigate predictors of clinical outcome in patients with mitral regurgitation undergoing percutaneous valve repair. The MITRA-UMG study, a single-centre registry, retrospectively collected consecutive patients with symptomatic moderate-to-severe or severe MR undergoing MitraClip therapy. The primary endpoint was the composite of cardiovascular death or rehospitalization for heart failure. Between March 2012 and July 2018, a total of 150 consecutive patients admitted to our institution were included. Procedural success was obtained in 95.3% of patients. The composite primary endpoint of cardiovascular death or rehospitalization for HF was met in 55 patients (37.9%) with cumulative incidences of 7.6%, 26.2%, at 30 days and 1-year, respectively. In the Cox multivariate model, NYHA functional class and left ventricular end-diastolic volume index (LVEDVi), independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan-Meier analysis, a LVEDVi > 92 ml/m² was associated with an increased incidence of the primary endpoint. In this study, patients presenting with dilated ventricles (LVEDVi > 92 ml/m²) and advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis after percutaneous mitral valve repair.

Figure 1

Primary endpoint of CV death or rehospitalization for HF according to left ventricular end-diastolic volume index. (A) At Kaplan–Meier analysis, a LVEDVi > 92 ml/m² was associated with an increased incidence of the primary endpoint (HR 2.55, 95% CI [1.5, 4.3], p < 0.001). (B) Functional mitral regurgitation subgroup analysis. At Kaplan–Meier estimates, a LVEDVi > 92 ml/m² was associated with an increased incidence of the primary endpoint (HR 2.09, 95% CI [1.1, 3.8], p = 0.034).

Figure 2

Secondary endpoints. (A) All-Cause Rehospitalization. At Kaplan–Meier analysis, no differences were found between the two groups (HR 1.48, 95% CI [0.94, 2.3], p = 0.09). (B) Rehospitalization for HF. At Kaplan–Meier analysis, a LVEDVi > 92 ml/m² was associated with an increased incidence rehospitalization for HF (HR 2.65, 95% CI [1.5, 4.6], p < 0.002). (C) All-Cause Death. At Kaplan–Meier analysis, no differences were found between the two groups (HR 1.55, 95% CI [0.7, 3.4], p = 0.28). (D) Cardiovascular Death. At Kaplan–Meier analysis, no differences were found between the two groups (HR 2.42, 95% CI [0.1, 5.9], p = 0.08).