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.
Similar content being viewed by others
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
References
Feldman T, Wasserman HS, Herrmann HC, Gray W, Block PC, Whitlow P, St Goar F, Rodriguez L, Silvestry F, Schwartz A, Sanborn TA, Condado JA, Foster E (2005) Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial. J Am Coll Cardiol 46:2134–2140
Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, Whitlow PL, Gray W, Low R, Herrmann HC, Lim S, Foster E, Glower D (2009) Everest Investigators. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol 54:686–694
Maisano F, Franzen O, Baldus S, Schäfer U, Hausleiter J, Butter C, Ussia GP, Sievert H, Richardt G, Widder JD, Moccetti T, Schillinger W (2013) Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J Am Coll Cardiol 62:1052–1061
Baldus S, Schillinger W, Franzen O, Bekeredjian R, Sievert H, Schofer J, Kuck KH, Konorza T, Mollmann H, Hehrlein C, Ouarrak T, Senges J, Meinertz T, German Transcatheter Mitral Valve Interventions (TRAMI) investigators (2012) MitraClip therapy in daily clinical practice: initial results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 14:1050–1055
Rossi A, Dini FL, Faggiano P, Agricola E, Cicoira M, Frattini S, Simioniuc A, Gullace M, Ghio S, Enriquez-Sarano M, Temporelli PL (2011) Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 97:1675–1680
Taramasso M, Maisano F, Latib A, Denti P, Buzzatti N, Cioni M, La Canna G, Colombo A, Alfieri O (2014) Clinical outcomes of MitraClip for the treatment of functional mitral regurgitation. EuroIntervention 10:746–752
Kaneko H, Suzuki S, Uejima T, Kano H, Matsuno S, Takai H, Oikawa Y, Yajima J, Aizawa T, Yamashita T (2014) Functional mitral regurgitation and left ventricular systolic dysfunction in the recent era of cardiovascular clinical practice, an observational cohort study. Hypertens Res 37:1082–1087
Kaneko H, Neuss M, Weissenborn J, Butter C (2016) Prognostic significance of right ventricular dysfunction in patients with functional mitral regurgitation undergoing MitraClip. Am J Cardiol 118:1717–1722
Kajimoto K, Sato N, Takano T, investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) registry (2016) Functional mitral regurgitation at discharge and outcomes in patients hospitalized for acute decompensated heart failure with a preserved or reduced ejection fraction. Eur J Heart Fail 18:1051–1059
Pighi M, Estevez-Loureiro R, Maisano F, Ussia GP, Dall’Ara G, Franzen O, Laroche C, Settergren M, Winter R, Nickenig G, Gilard M, Di Mario C, Transcatheter Valve Treatment (TCVT) Sentinel Registry Investigators of the EURObservational Research Programme (EORP) of the European Society of Cardiology (2017) Immediate and 12-month outcomes of ischemic versus nonischemic functional mitral regurgitation in patients treated with Mitraclip (from the 2011 to 2012 pilot sentinel registry of percutaneous edge-to-edge mitral valve repair of the European Society of Cardiology). Am J Cardiol 119:630–637
Michler RE, Smith PK, Parides MK, Ailawadi G, Thourani V, Moskowitz AJ, Acker MA, Hung JW, Chang HL, Perrault LP, Gillinov AM, Argenziano M, Bagiella E, Overbey JR, Moquete EG, Gupta LN, Miller MA, Taddei-Peters WC, Jeffries N, Weisel RD, Rose EA, Gammie JS, DeRose JJ Jr, Puskas JD, Dagenais F, Burks SG, El-Hamamsy I, Milano CA, Atluri P, Voisine P, O’Gara PT, Gelijns AC, for the CTSN (2016) Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 374:1932–1941
Feldman T, Mehta A, Guerrero M, Levisay JP, Salinger MH (2016) MitraClip therapy for mitral regurgitation: secondary mitral regurgitation. Interv Cardiol Clin 5:83–91
Schäfer U, Maisano F, Butter C, Franzen O, Baldus S, Hausleiter J, Ussia GP, Sievert H, Geist V, Widder JD, Moccetti T, Schillinger W (2016) Impact of preprocedural left ventricular ejection fraction on 1-year outcomes after MitraClip implantation (from the ACCESS-EU phase I, a prospective, multicenter, nonrandomized postapproval study of the MitraClip therapy in Europe). Am J Cardiol 118:873–880
Capodanno D, Adamo M, Barbanti M, Giannini C, Laudisa ML, Cannata S, Curello S, Imme S, Maffeo D, Bedogni F, Petronio AS, Ettori F, Tamburino C, Grasso C, Grasp-It Investigators (2015) Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair. Am Heart J 170:187–195
Matsumoto T, Nakamura M, Yeow WL, Hussaini A, Ram V, Makar M, Gurudevan SV, Trento A, Siegel RJ, Kar S (2014) Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair. Am J Cardiol 114:1735–1739
Ellis SG, Whitlow PL, Raymond RE, Schneider JP (2002) Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention. Am J Cardiol 89:315–318
Deja MA, Grayburn PA, Sun B, Rao V, She L, Krejca M, Jain AR, Leng Chua Y, Daly R, Senni M, Mokrzycki K, Menicanti L, Oh JK, Michler R, Wrobel K, Lamy A, Velazquez EJ, Lee KL, Jones RH (2012) Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation 125:2639–2648
Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Detaint D, Vanoverschelde JL, Butchart EG, Ravaud P, Vahanian A (2007) What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 28:1358–1365
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ (2017) Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 30:303–371
Di Donato M, Dabic P, Castelvecchio S, Santambrogio C, Brankovic J, Collarini L, Joussef T, Frigiola A, Buckberg G, Menicanti L, Group R (2006) Left ventricular geometry in normal and post-anterior myocardial infarction patients: sphericity index and ‘new’ conicity index comparisons. Eur J Cardiothorac Surg 29(Suppl 1):S225–S230
Nagasaki M, Nishimura S, Ohtaki E, Kasegawa H, Matsumura T, Nagayama M, Koyanagi T, Tohbaru T, Misu K, Asano R, Sumiyoshi T, Hosoda S (2006) The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy. Int J Cardiol 108:171–176
Juliani PS, Das-Neves-Pereira JC, Monteiro R, Correia AT, Moreira LFP, Jatene FB (2018) Left ventricular chamber geometry in cardiomyopathies: insights from a computerized anatomical study. ESC Heart Fail 5:355–364
Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L (2011) Everest II Investigators. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 364:1395–1406
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Munoz DR, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38:2739–2791
Neuss M, Schau T, Schoepp M, Seifert M, Holschermann F, Meyhofer J, Butter C (2013) Patient selection criteria and midterm clinical outcome for MitraClip therapy in patients with severe mitral regurgitation and severe congestive heart failure. Eur J Heart Fail 15:786–795
Godino C, Salerno A, Cera M, Agricola E, Fragasso G, Rosa I, Oppizzi M, Monello A, Scotti A, Magni V, Montorfano M, Cappelletti A, Margonato A, Colombo A (2016) Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation. Int J Cardiol Heart Vasc 11:90–98
Giannini C, Fiorelli F, Colombo A, De Carlo M, Weisz SH, Agricola E, Godino C, Castriota F, Golino P, Petronio AS (2016) Right ventricular evaluation to improve survival outcome in patients with severe functional mitral regurgitation and advanced heart failure undergoing MitraClip therapy. Int J Cardiol 223:574–580
Park SJ, Park JH, Lee HS, Kim MS, Park YK, Park Y, Kim YJ, Lee JH, Choi SW, Jeong JO, Kwon IS, Seong IW (2015) Impaired RV global longitudinal strain is associated with poor long-term clinical outcomes in patients with acute inferior STEMI. JACC Cardiovasc Imaging 8:161–169
Mentias A, Raza MQ, Barakat AF, Hill E, Youssef D, Krishnaswamy A, Desai MY, Griffin B, Ellis S, Menon V, Tuzcu EM, Kapadia SR (2017) Prognostic significance of ischemic mitral regurgitation on outcomes in acute ST-elevation myocardial infarction managed by primary percutaneous coronary intervention. Am J Cardiol 119:20–26
Bouma W, Willemsen HM, Lexis CP, Prakken NH, Lipsic E, van Veldhuisen DJ, Mariani MA, van der Harst P, van der Horst IC (2016) Chronic ischemic mitral regurgitation and papillary muscle infarction detected by late gadolinium-enhanced cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction. Clin Res Cardiol 105:981–991
Giannini C, Petronio AS, De Carlo M, Guarracino F, Conte L, Fiorelli F, Pieroni A, Di Bello V (2014) Integrated reverse left and right ventricular remodelling after MitraClip implantation in functional mitral regurgitation: an echocardiographic study. Eur Heart J Cardiovasc Imaging 15:95–103
Schwencke C, Bijuklic K, Ouarrak T, Lubos E, Schillinger W, Plicht B, Eggebrecht H, Baldus S, Schymik G, Boekstegers P, Hoffmann R, Senges J, Schofer J (2017) Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol 106:249–258
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-018-1352-x