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Observational Study
. 2024 Jun;17(6):e013794.
doi: 10.1161/CIRCINTERVENTIONS.123.013794. Epub 2024 Apr 17.

Cardiac Damage in Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Edge-to-Edge Repair

Atsushi Sugiura #  1 , Masanori Yamamoto #  2   3   4 , Mike Saji  5   6 , Masahiko Asami  7 , Yusuke Enta  8 , Masaki Nakashima  8 , Shinichi Shirai  9 , Masaki Izumo  10 , Shingo Mizuno  11 , Yusuke Watanabe  12 , Makoto Amaki  13 , Kazuhisa Kodama  14 , Junichi Yamaguchi  15 , Yoshifumi Nakajima  16 , Toru Naganuma  17 , Hiroki Bota  18 , Yohei Ohno  19 , Masahiro Yamawaki  20 , Hiroshi Ueno  21 , Kazuki Mizutani  22 , Yuya Adachi  2   3 , Toshiaki Otsuka  23 , Shunsuke Kubo  24 , Georg Nickenig  1 , Kentaro Hayashida  25 ; OCEAN-Mitral Investigators
Affiliations
Observational Study

Cardiac Damage in Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Edge-to-Edge Repair

Atsushi Sugiura et al. Circ Cardiovasc Interv. 2024 Jun.

Abstract

Background: The extent of cardiac damage and its association with clinical outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation remains unclear. This study was aimed to investigate cardiac damage in patients with degenerative mitral regurgitation treated with TEER and its association with outcomes.

Methods: We analyzed patients with degenerative mitral regurgitation treated with TEER in the Optimized Catheter Valvular Intervention-Mitral registry, which is a prospective, multicenter observational data collection in Japan. The study subjects were classified according to the extent of cardiac damage at baseline: no extravalvular cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate left ventricular or left atrial damage (stage 2), or right heart damage (stage 3). Two-year mortality after TEER was compared using Kaplan-Meier analysis.

Results: Out of 579 study participants, 8 (1.4%) were classified as stage 0, 76 (13.1%) as stage 1, 319 (55.1%) as stage 2, and 176 (30.4%) as stage 3. Two-year survival was 100% in stage 0, 89.5% in stage 1, 78.9% in stage 2, and 75.3% in stage 3 (P=0.013). Compared with stage 0 to 1, stage 2 (hazard ratio, 3.34 [95% CI, 1.03-10.81]; P=0.044) and stage 3 (hazard ratio, 4.51 [95% CI, 1.37-14.85]; P=0.013) were associated with increased risk of 2-year mortality after TEER. Significant reductions in heart failure rehospitalization rate and New York Heart Association functional scale were observed following TEER (both, P<0.001), irrespective of the stage of cardiac damage.

Conclusions: Advanced cardiac damage is associated with an increased risk of mortality in patients undergoing TEER for degenerative mitral regurgitation.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023653.

Keywords: cardiac damage; degenerative mitral regurgitation; heart failure; risk stratification; transcatheter edge-to-edge repair.

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Conflict of interest statement

Disclosures Dr Sugiura has received research grant from Edwards and honoraria for lectures from Edwards Lifesciences and Abbott Medical, outside the submitted work. Drs Kubo, Saji, Izumo, Watanabe, and Amaki are clinical proctors of transcatheter edge-to-edge repair for Abbott Medical, and have received consultant fee from Abbott Medical. Drs Asami and Kodama have received speaker fees from Abbott Medical. Drs Yamamoto and Nakajima are clinical proctors of transcatheter edge-to-edge repair for Abbott Medical and have received lecture fees from Abbott Medical. Dr Yamaguchi is clinical proctor of transcatheter edge-to-edge repair for Abbott Medical and has received a lecture fee and a scholarship donation from Abbott Medical. Dr Ohno has received consultant, advisor, and speaker fees from Abbott Medical. Drs Enta, Shirai, Mizuno, and Bota are clinical proctors of transcatheter edge-to-edge repair for Abbott Medical. Dr Nickenig has received research grants and speaker honoraria from Abbott, outside the submitted work. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Staging stratification of degenerative mitral regurgitation based on the extent of cardiac damage. Cardiac stratification of degenerative mitral regurgitation based on the extent of cardiac damage. LA indicates left atrial; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic dimension; RVFAC, right ventricular fractional area change; TAPSE, tricuspid annular plane systolic excursion; and TR, tricuspid regurgitation.
Figure 2.
Figure 2.
Two-year outcomes after transcatheter edge-to-edge repair according to the extent of cardiac damage. A, Survival curves according to cardiac damage. B, Event-free survival from cardiovascular mortality. LA indicates left atrial; LV, left ventricular; and RV, right ventricular.
Figure 3.
Figure 3.
Association of cardiac stage with mortality in selected subgroups. Forrest plots show the association of cardiac damage with all-cause mortality in each subgroup. HFH indicates heart failure hospitalization; HR, hazard ratio; and NYHA, New York Heart Association.
Figure 4.
Figure 4.
Regress in staging classification after transcatheter edge-to-edge repair. Distribution of the cardiac damage stages at baseline, 30 d, and 1 y.
Figure 5.
Figure 5.
Reduction in hospitalization after transcatheter edge-to-edge repair (TEER). Hospitalization rates (events per patient-year) before and after TEER.
Figure 6.
Figure 6.
Change in New York Heart Association (NYHA) functional scale according to cardiac damage. NYHA functional scale at baseline and 1 y according to each stage of cardiac damage.
Figure 7.
Figure 7.
Echocardiographic follow-up after transcatheter edge-to-edge repair (TEER). Severity of mitral regurgitation (MR), repeat mitral valve (MV) treatment, or mortality at 1-mo and 1-y follow-up after TEER.
See this image and copyright information in PMC

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