AI Article Synopsis

  • - The study investigates how mismatched residual mitral regurgitation (MR) and left atrial pressure (LAP) after a specific heart procedure (TEER) can negatively impact clinical outcomes in patients with severe MR and heart failure.
  • - Researchers categorized 1,477 patients into three groups based on their MR and LAP levels, finding that those with mismatched or poor conditions faced higher risks of death and heart failure hospitalization compared to those in an optimal state.
  • - Six key factors were identified as predictors of hemodynamic mismatch after TEER, including body mass index and pre-procedural pressures, suggesting that monitoring these could help improve patient outcomes.

Article Abstract

Background: The mechanism and impact of mismatch between residual mitral regurgitation (MR) and postprocedural left atrial pressure (LAP) after transcatheter edge-to-edge repair (TEER), which may adversely affect clinical outcome, is of great interest.

Objectives: This study aimed to examine the effect of hemodynamic mismatch after TEER on clinical outcomes in patients with heart failure due to severe MR and investigate the predictive factors for the mismatch using a prospective multicenter registry.

Methods: We categorized 1,477 patients into optimal (residual MR grade ≤1 and postprocedural LAP ≤15 mm Hg), mismatched (residual MR grade >1 or postprocedural LAP >15 mm Hg), and poor (residual MR grade >1 and postprocedural LAP >15 mm Hg) groups and examined their prognosis. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.

Results: There were 927 (62.7%), 459 (31.1%), and 91 (6.2%) patients categorized into optimal, mismatched, and poor groups, respectively. Cox regression analysis, referenced to the optimal group, revealed that the mismatched and poor groups exhibited a higher risk for the primary endpoint (HR: 1.55; 95% CI: 1.28-1.88; and HR: 1.95; 95% CI: 1.38-2.74, respectively). Six risk factors were identified as predictors of hemodynamic mismatch after TEER: body mass index, baseline left atrial volume index, atrial fibrillation, tricuspid annular plane systolic excursion value, preprocedural mean left atrial pressure, and postprocedural mean mitral valve pressure gradient.

Conclusions: Post-TEER hemodynamic mismatch between residual MR and postprocedural LAP was associated with a poor prognosis. Six readily accessible perioperative parameters predict the hemodynamic mismatch. (OCEAN-Mitral registry; UMIN000023653).

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Source
http://dx.doi.org/10.1016/j.jcin.2024.07.046DOI Listing

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