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Review
. 2025 Mar 27;15(7):852.
doi: 10.3390/diagnostics15070852.

The Prognostic Value of Pulmonary Hypertension in Patients with Mitral Regurgitation Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis

Shancuoji  1   2 , Yanbiao Liao  1   2 , Junli Li  1   2 , Mao Chen  1   2
Affiliations
Review

The Prognostic Value of Pulmonary Hypertension in Patients with Mitral Regurgitation Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis

Shancuoji et al. Diagnostics (Basel). .

Abstract

Background: Pulmonary hypertension (PH) is associated with the outcomes of mitral valve transcatheter edge-to-edge repair (M-TEER) in patients with severe mitral regurgitation (MR). However, the prognosis of baseline PH on MR patients after M-TEER has been controversial. This meta-analysis aimed to determine the prognostic value of PH with early and late outcomes after M-TEER with MitraClip. Methods: We systematically searched PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science for studies. The results of the meta-analysis are summarized as the hazard ratio (HR), odds ratios (ORs) or mean difference (MD) and 95% confidence interval (CI). Results: A total of 20 publications were included in the systematic review, of which six were observational cohort studies including 5684 patients. The pooled incidence estimate of all-cause mortality was more common in severe PH than in patients who were non-PH. On pooled multivariate analysis, baseline PH was associated with late (≥1-year) all-cause mortality (HR = 1.61, 95% CI [1.23-2.11]) and the combined outcome of late HF rehospitalization and all-cause mortality (HR = 1.33, 95% CI [1.15-1.53]) after M-TEER. The level of SPAP significantly decreased after MitraClip in MR patients with PH (MD = -12.33 mmHg, 95% CI [-14.08--10.58]). Conclusions: Baseline PH had a worse prognosis of early (≥30-day) cardiac mortality, late all-cause mortality as well as the composite outcome of HF rehospitalization and all-cause mortality after M-TEER compared to non-PH patients. Future studies are needed to prove these findings.

Keywords: MitraClip; mitral regurgitation; pulmonary hypertension; transcatheter edge-to-edge repair; transcatheter mitral valve repair.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study selection. Flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Figure 2
Figure 2
(A) Pooled ORs for early (≥30-day) cardiac and non-cardiac mortality. (B) Pooled ORs for early (30-day) and late (≥1-year) all-cause mortality [14,23,24,28].
Figure 2
Figure 2
(A) Pooled ORs for early (≥30-day) cardiac and non-cardiac mortality. (B) Pooled ORs for early (30-day) and late (≥1-year) all-cause mortality [14,23,24,28].
Figure 3
Figure 3
Forest plot summarizing mean difference (MD) for SPAP pre and post TMVr [14,27,28].
Figure 4
Figure 4
Pooled outcome of ≥1-year heart failure-related rehospitalization rates after TEER using MitraClip (univariate analysis) [15,20,23,28].
Figure 5
Figure 5
(A) Pooled hazard ratios (HRs) for late (≥1-year) all-cause mortality after TEER using MitraClip (Univariate analysis). (B) Pooled HR for late (≥1-year) all-cause mortality after TEER using MitraClip (multivariable analysis). (C) Pooled HR for the combined outcome of late (≥1-year) heart failure-related rehospitalization and all-cause mortality after TMVr using MitraClip (multivariable analysis) [14,15,16,17,18,19,20,21,22,23,25,26,28,29,30,31,32].
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