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Hemodynamic Profiles and Clinical Response to TEER
Quick Takes
- Among patients undergoing mitral valve TEER, optimal hemodynamic profile, consisting of normal postprocedural left atrial pressure [LAP] (i.e., mLAP <15 mm Hg) and mild or no residual MR after TEER is associated with superior survival and clinical outcomes.
- Hemodynamic profiling with LAP assessment was strongly predictive of a positive clinical response to TEER at 1-year follow-up and remained predictive in multivariable analyses.
- These data suggest that assessment of LAP should be routinely considered in conjunction with residual MR assessment in patients undergoing mitral TEER.
Study Questions:
What is the relation between hemodynamic profiles and outcomes following mitral transcatheter edge-to-edge repair (TEER)?
Methods:
The investigators defined three hemodynamic profiles among 378 patients (median age, 82 years; 43.9% women), using residual left atrial pressure (LAP) and mitral regurgitation (MR): type I (optimal), grade ≤1 MR and mean LAP (mLAP) ≤15 mm Hg; type II (mixed), MR grade >1 or mLAP >15 mm Hg; and type III (poor), MR grade >1 and mLAP >15 mm Hg. The discrimination of these profiles for predicting outcomes was then examined. A positive clinical response to TEER was defined as improvement in New York Heart Association functional class ≥I grade at 1 year without heart failure rehospitalization or death. The Kaplan-Meier method was used to calculate survival estimates for the endpoints, with comparisons performed using the log-rank test. Cox proportional hazards models were used to estimate the association between the risk of the endpoints and the hemodynamic profiles. A multivariable logistic regression analysis was performed to examine clinical predictors of all-cause death.
Results:
There were 148 (39.0%) patients classified as optimal (type I), 187 (49.0%) patients as mixed (type II), and 43 (11.0%) patients as poor (type III). For all-cause mortality, survival at 1 year was 91.6%, 82.6%, and 67.9% for types I, II, and III, respectively (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.44-3.15; p < 0.001). For the composite endpoint of all-cause mortality and rehospitalization for heart failure, event-free survival at 1 year was 84.1%, 70.7%, and 53.2% for types I, II, and III, respectively (HR, 1.93; 95% CI, 1.41-2.65; p < 0.001). Hemodynamic profiling was strongly associated with a positive response to TEER, occurring in 73.9%, 57.0%, 35.0%, for types I, II, and III, respectively (p < 0.001).
Conclusions:
The authors reported superior survival occurring among patients with optimal reduction in MR and normal postprocedural LAP.
Perspective:
This study observed superior survival and clinical outcomes with an optimal hemodynamic profile among patients undergoing TEER, consisting of normal postprocedural LAP (i.e., mLAP <15 mm Hg) and mild or no residual MR after TEER. Furthermore, hemodynamic profiling with LAP assessment was strongly predictive of a positive clinical response to TEER at 1-year follow-up and remained predictive in multivariable analyses that adjusted for age, morbidities, and left ventricular function, and was a stronger predictor than residual MR alone. These data suggest that assessment of LAP should be routinely considered in conjunction with residual MR assessment in patients undergoing mitral TEER.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation
Keywords: Atrial Pressure, Geriatrics, Heart Failure, Heart Valve Diseases, Hemodynamics, Mitral Valve Insufficiency, Morbidity, Secondary Prevention, Survival, Transcatheter Aortic Valve Replacement, Ventricular Function, Left
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