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. 2021 Oct;12(5):302-308.
doi: 10.14740/cr1284. Epub 2021 Jul 28.

Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission

David M Tehrani  1 , Jiexi Wang  1 , Parntip Lai  1 , Pooja S Desai  1 , Heajung L Nguyen  1 , Lisa Bang  1 , Eric H Yang  1 , Gabriel Vorobiof  1 , Ali Nsair  1 , Olcay Aksoy  1 , Marcella Calfon Press  1   2 , Rushi V Parikh  1   2
Affiliations

Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission

David M Tehrani et al. Cardiol Res. 2021 Oct.

Abstract

Background: Pre-existing pulmonary hypertension is associated with poor outcomes after transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR). However, the impact of an immediate change in mean pulmonary artery pressure (ΔmPAP) following TMVr on outcomes is unknown.

Methods: Patients who underwent TMVr from December 2015 to February 18, 2020 at our institution for symptomatic 3-4+ MR and who had invasive hemodynamics measured immediately pre- and post-TMVR were included. Multivariate Cox regression analysis was performed to examine the association of ΔmPAP (post-TMVr - pre-TMVr mPAP) with the primary endpoint of heart failure (HF) readmission at 1 year. Secondary endpoints included all-cause mortality and the composite endpoint of HF readmission or all-cause mortality at 1 year.

Results: Among 55 patients, 55% were men, mean age was 72 ± 14.2 years, and mean ΔmPAP was -1.4 ± 8.2 mm Hg. Overall, HF readmission occurred in 14 (25%), death in 10 (18%), and the composite endpoint in 20 (36%) patients. In multivariable analyses, higher ΔmPAP was significantly associated with HF readmission (hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00 - 1.21; P = 0.04). ΔmPAP was not associated with death (HR = 1.04, 95% CI: 0.96 - 1.14; P = 0.33), though there was a numerical but statistically non-significant trend towards the composite endpoint (HR = 1.06, 95% CI: 1.00 - 1.13; P = 0.06) driven by HF readmission.

Conclusion: Higher ΔmPAP immediately following TMVr was associated with increased HF readmission at 1 year. Larger prospective studies are needed to validate these data and further explore the utility of ΔmPAP as a novel hemodynamic parameter to predict post-TMVR outcomes.

Keywords: Heart failure readmission; MitraClip; Mitral regurgitation; Mortality.

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Conflict of interest statement

MCP is a proctor for the Abbott MitraClip Procedure. No other authors have relevant disclosures. RVP reports unrelated activities including research support from the American Heart Association, consulting fees from Abbott, and serving on the scientific advisory board (minor equity interest) of Stallion Cardio, DocVocate, and HeartCloud.

Figures

Figure 1
Figure 1
Immediate change in invasively measured mPAP after TMVr. Patients free from HF readmission (a) and those with a HF readmission (b) at 1 year are depicted with their immediate pre- and post-TMVr mPAP after undergoing TMVr. HF: heart failure; mPAP: mean pulmonary artery pressure; TMVr: transcatheter mitral valve repair.
See this image and copyright information in PMC

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