René Vollenbroich1, Stefan Stortecky1, Fabien Praz1, Jonas Lanz1, Anna Franzone1, Katarzyna Zuk2, Dik Heg3, Marco Valgimigli1, Crochan John O'Sullivan4, Corinna Heinisch5, Eva Roost2, Peter Wenaweser6, Stephan Windecker1, Thomas Pilgrim7. 1. Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland. 2. Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland. 3. Clinical Trials Unit, Department of Clinical Research, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. 4. Department of Cardiology, Triemli Hospital, Zurich, Switzerland. 5. Department of Cardiology, Hospital Interlaken, Interlaken, Switzerland. 6. Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland; Department of Cardiology, Klinik im Park, Zurich, Switzerland. 7. Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.
Abstract
BACKGROUND: Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology. METHODS: In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up. RESULTS: Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline. CONCLUSION: Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.
BACKGROUND: Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology. METHODS: In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up. RESULTS: Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline. CONCLUSION:Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.
Authors: R Jansen; A M Wind; M J Cramer; F Nijhoff; P Agostoni; F Z Ramjankhan; W J Suyker; P R Stella; S A J Chamuleau Journal: Int J Cardiovasc Imaging Date: 2018-03-10 Impact factor: 2.357
Authors: Nahoko Kato; Jeremy J Thaden; William R Miranda; Christopher G Scott; Maurice E Sarano; Kevin L Greason; Patricia A Pellikka Journal: ESC Heart Fail Date: 2021-10-15
Authors: Luciana de Cerjat Bernardes P da Cunha; Enio Eduardo Guerios; Claudio Leinig Pereira da Cunha; Luiz A Carvalho; Pedro Lemos Neto; Rogério Sarmento-Leite; Alexandre A Abizaid; José Antonio Mangione; Adriano Dourado Oliveira; Alexandre Siciliano; Vinicius Esteves; Fábio Sândoli de Brito Journal: Arq Bras Cardiol Date: 2021-06 Impact factor: 2.000