Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Nov 5;13(21):e035109.
doi: 10.1161/JAHA.124.035109. Epub 2024 Oct 22.

Clinical Impact of Baseline Frailty Status and Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry

Takahiro Tokuda  1 , Masanori Yamamoto  1   2   3 , Ai Kagase  1 , Testuro Shimura  3 , Ryo Yamaguchi  2 , Mike Saji  4 , Masahiko Asami  5 , Yusuke Enta  6 , Masaki Nakashima  6 , Shinichi Shirai  7 , Masaki Izumo  8 , Shingo Mizuno  9 , Yusuke Watanabe  10 , Makoto Amaki  11 , Kazuhisa Kodama  12 , Junichi Yamaguchi  13 , Yoshifumi Nakajima  14 , Toru Naganuma  15 , Hiroki Bota  16 , Yohei Ohno  17 , Masahiro Yamawaki  18 , Hiroshi Ueno  19 , Kazuki Mizutani  20 , Toshiaki Otsuka  21 , Shunsuke Kubo  22 , Kentaro Hayashida  23 ; OCEAN‐Mitral Investigators
Affiliations
Multicenter Study

Clinical Impact of Baseline Frailty Status and Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry

Takahiro Tokuda et al. J Am Heart Assoc. .

Abstract

Background: The Clinical Frailty Scale (CFS) is a useful frailty marker for predicting clinical outcomes in patients undergoing invasive therapy. However, the clinical impact of CFS after transcatheter edge-to-edge repair in patients with mitral regurgitation (MR) remains unclear. This study aimed to elucidate the association between the baseline frail status defined by the CFS and clinical outcomes with or without postprocedural MR ≥2+ (post-MR ≥2+) after transcatheter edge-to-edge repair.

Methods and results: Based on a Japanese multicenter registry (OCEAN [Optimized Catheter Valvular Intervention]-Mitral), data from 2078 patients with MR who underwent transcatheter edge-to-edge repair were analyzed. The patients were classified into 5 groups: CFS 1 to 3, 4, 5, 6, and ≥7. The procedural and clinical outcomes and post-MR ≥2+ were compared among the groups. All-cause mortality for up to 2 years was explored using Cox proportional hazards regression analysis. Although the rates of acute procedural success and post-MR ≥2+ were similar, all-cause mortality at 2 years was significantly increased across the 5 CFS categories (15.5%, 23.8%, 27.7%, 34.6%, and 48.8%, respectively, P<0.001). The incremental CFS categories and post-MR ≥2+ were independent predictive risk factors of all-cause mortality (all P<0.05). Among the patients with 5 CFS categories, the incidence of all-cause mortality was higher in those with post-MR ≥2+ than in those without (all P<0.05).

Conclusions: Although prognosis was poor in patients with higher CFS grade after transcatheter edge-to-edge repair, minimizing modifiable factors of residual MR is warranted to improve the clinical outcomes.

Registration information: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.

Keywords: Clinical Frailty Scale; residual mitral regurgitation; risk stratification; transcatheter edge‐to‐edge repair.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Patient flowchart of this study.
CFS indicates the Clinical Frailty Scale; OCEAN‐Mitral, Optimized Catheter Valvular Intervention)‐Mitral; and TEER, transcatheter edge‐to‐edge repair.
Figure 2
Figure 2. Kaplan‐Meier curve of all‐cause mortality at 2 years in the CFS 1 to 3, 4, 5, 6, and ≥7 groups (A), and Kaplan‐Meier curve of all‐cause mortality and HF hospitalization at 2 years in the CFS 1 to 3, 4, 5, 6, and ≥7 groups (B).
CFS indicates the Clinical Frailty Scale; HF, heart failure; and TEER, transcatheter edge‐to‐edge repair.
Figure 3
Figure 3. Kaplan‐Meier curve of all‐cause mortality at 2 years according to frail status and MR cause.
CFS indicates the Clinical Frailty Scale; FMR, functional mitral regurgitation; MR, mitral regurgitation; and TEER, transcatheter edge‐to‐edge repair.
Figure 4
Figure 4. Periprocedural results and in‐hospital mortality according to frailty status and the all‐cause mortality at 2 years in each group with or without post‐MR ≥2+.
APS indicates acute procedural success; CFS, Clinical Frailty Scale; MR, mitral regurgitation; and TEER, transcatheter edge‐to‐edge repair.
See this image and copyright information in PMC

References

    1. Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, et al. Transcatheter mitral‐valve repair in patients with heart failure. N Engl J Med. 2018;379:2307–2318. doi: 10.1056/NEJMoa1806640 - DOI - PubMed
    1. Bandeen‐Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue QL, Walston JD, Kasper JD. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70:1427–1434. doi: 10.1093/gerona/glv133 - DOI - PMC - PubMed
    1. Clinical Frailty Scale‐Geriatric Medicine Research‐Dalhousie University . Faculty of Medicine, geriatric medicine research, research/projects, clinical frailty scale. Dalhousie University, Halifax, Canada. Accessed March 5, 2017.
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–495. doi: 10.1503/cmaj.050051 - DOI - PMC - PubMed
    1. Donnan MT, Bihari S, Subramaniam A, Dabscheck EJ, Riley B, Pilcher DV. The long‐term impact of frailty after an intensive care unit admission due to chronic obstructive pulmonary disease. Chronic Obstr Pulm Dis. 2024;11:83–94. doi: 10.15326/jcopdf.2023.0453 - DOI - PMC - PubMed

Publication types

LinkOut - more resources