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Predictors of mortality in ischaemic versus non-ischaemic functional mitral regurgitation after successful transcatheter mitral valve repair using MitraClip: results from two high-volume centres

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Abstract

Introduction

Transcatheter edge-to-edge mitral valve repair using the MitraClip has been widely performed in surgical high-risk patients with reduced left ventricular systolic function and severe functional mitral regurgitation (FMR). Ischaemic heart disease is the leading aetiology of heart disease worldwide. We aimed to assess the clinical implications of ischaemic aetiology in patients with severe FMR who underwent MitraClip implantation.

Methods and results

From two high-volume centres in Germany, we retrospectively compared the clinical outcomes and clinical predictors of all-cause mortality after MitraClip implantation in patients with ischaemic (I-FMR) and non-ischaemic FMR (NI-FMR). In the overall FMR cohort (n = 575), there were 336 (58%) patients with I-FMR and 239 (42%) with NI-FMR. There was no significant difference in survival between the two groups (log-rank p = 0.78). In a multivariable Cox regression analysis of all-cause mortality, different predictors were observed for either group. In I-FMR patients, decreasing tricuspid annular systolic excursion [adjusted hazard ratio (HRadj) 1.06, 95% confidence interval (95% CI) 1.01–1.14 /1 mm, p = 0.028] and increasing logistic EuroSCORE (HRadj 1.02, 95% CI 1.00–1.03, p = 0.037) were independent predictors, whereas in NI-FMR patients, NT-pro BNP (HRadj 1.05, 95% CI 1.02–1.08, p = 0.001) and age (HRadj 1.06, 95% CI 1.01–1.11, p = 0.013) were independently predictive of mortality.

Conclusions

Despite the similar survival between ischaemic and non-ischaemic FMR, different predictors of all-cause mortality were demonstrated. Further clinical studies are mandated to focus on each FMR subgroup with stratification by ischaemic origin.

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Abbreviations

CABG:

Coronary artery bypass grafting

CAD:

Coronary artery disease

eGFR:

Estimated glomerular filtration rate

FMR:

Functional mitral regurgitation

HF:

Heart failure

IQR:

Interquartile range

LV:

Left ventricle/ventricular

logES:

logistic EuroSCORE

MR:

Mitral regurgitation

NT-proBNP:

N-terminal pro-brain natriuretic peptide

NYHA:

New York Heart Association

RV:

Right ventricle/ventricular

TAPSE:

Tricuspid annular plane systolic excursion

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Authors and Affiliations

  1. Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

    Mitsunobu Kitamura, Dimitry Schewel, Tobias Schmidt, Hannes Alessandrini, Felix Kreidel, Karl-Heinz Kuck & Christian Frerker

  2. Heart Center Brandenburg in Bernau/Berlin & Medical School Brandenburg (MHB), Bernau, Germany

    Hidehiro Kaneko, Michael Neuss & Christian Butter

  3. Asklepios Proresearch, Hamburg, Germany

    Michael Schlüter

Authors
  1. Mitsunobu Kitamura
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  2. Hidehiro Kaneko
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  4. Dimitry Schewel
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  8. Michael Neuss
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  9. Christian Butter
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  10. Karl-Heinz Kuck
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  11. Christian Frerker
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Corresponding author

Correspondence to Christian Frerker.

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Conflict of interest

Dr. Kuck has received research funding from Abbott Vascular. Dr. Frerker, Dr. Butter, and Dr. Neuss have received lecture honoraria and travel grants from Abbott Laboratories, Abbott Park (Illinois, USA). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethical approval

All patients provided written informed consent and the study protocol conformed to the ethical guidelines of the 1964 Declaration of Helsinki and its later amendments.

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Kitamura, M., Kaneko, H., Schlüter, M. et al. Predictors of mortality in ischaemic versus non-ischaemic functional mitral regurgitation after successful transcatheter mitral valve repair using MitraClip: results from two high-volume centres. Clin Res Cardiol 108, 264–272 (2019). https://doi.org/10.1007/s00392-018-1352-x

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  • DOI: https://doi.org/10.1007/s00392-018-1352-x

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