Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair
Background Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge‐to‐edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033510 |
| _version_ | 1797205520278355968 |
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| author | Rody G. Bou Chaaya Taha Hatab Sahar Samimi Fatima Qamar Chloe Kharsa Joe Aoun Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman Sherif F. Nagueh William A. Zoghbi Ashrith Guha Syed Zaid Sachin S. Goel |
| author_facet | Rody G. Bou Chaaya Taha Hatab Sahar Samimi Fatima Qamar Chloe Kharsa Joe Aoun Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman Sherif F. Nagueh William A. Zoghbi Ashrith Guha Syed Zaid Sachin S. Goel |
| author_sort | Rody G. Bou Chaaya |
| collection | DOAJ |
| description | Background Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge‐to‐edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge‐to‐edge repair. Methods and Results We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge‐to‐edge repair. The end points were all‐cause mortality and a composite of mortality and heart failure hospitalization at 2 years. Using the receiver operating characteristic curve–derived threshold of 0.6 for pulmonary effective arterial elastance ([Ea], pulmonary artery systolic pressure/stroke volume), patients were stratified into 3 profiles based on PH severity (low elastance [HE]: Ea <0.6/mean pulmonary artery pressure (mPAP)) <35; High Elastance with No/Mild PH (HE−): Ea ≥0.6/mPAP <35; and HE with Moderate/Severe PH (HE+): Ea ≥0.6/mPAP ≥35) and MR pathogenesis (Primary MR [PMR])/low elastance, PMR/HE, and secondary MR). The association between this classification and clinical outcomes was examined using Cox regression. Among 114 patients included, 50.9% had PMR. Mean±SD age was 74.7±10.6 years. Patients with Ea ≥0.6 were more likely to have diabetes, atrial fibrillation, New York Heart Association III/IV status, and secondary MR (all P<0.05). Overall, 2‐year cumulative survival was 71.1% and was lower in patients with secondary MR and mPAP ≥35. Compared with patients with low elastance, cumulative 2‐year event‐free survival was significantly lower in HE− and HE+ patients (85.5% versus 50.4% versus 41.0%, respectively, P=0.001). Also, cumulative 2‐year event‐free survival was significantly higher in patients with PMR/low elastance when compared with PMR/HE and patients with secondary mitral regurgitation (85.5% versus 55.5% versus 46.1%, respectively, P=0.005). Conclusions Assessment of the preprocedural cardiopulmonary profile based on mPAP, MR pathogenesis, and Ea guides patient selection by identifying hemodynamic features that indicate likely benefit from mitral‐transcatheter edge‐to‐edge repair in PH or lack thereof. |
| first_indexed | 2024-04-24T08:52:25Z |
| format | Article |
| id | doaj.art-a72f50da69244c9e94fba5318a050261 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T08:52:25Z |
| publishDate | 2024-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-a72f50da69244c9e94fba5318a0502612024-04-16T09:33:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-04-0113810.1161/JAHA.123.033510Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge RepairRody G. Bou Chaaya0Taha Hatab1Sahar Samimi2Fatima Qamar3Chloe Kharsa4Joe Aoun5Nadeen Faza6Stephen H. Little7Marvin D. Atkins8Michael J. Reardon9Neal S. Kleiman10Sherif F. Nagueh11William A. Zoghbi12Ashrith Guha13Syed Zaid14Sachin S. Goel15Houston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXDepartment of Cardiovascular Surgery Houston Methodist Hospital Houston TXDepartment of Cardiovascular Surgery Houston Methodist Hospital Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXDepartment of Cardiology Baylor School of Medicine and the Michael E DeBakey VAMC Houston TXHouston Methodist DeBakey Heart and Vascular Center Houston TXBackground Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge‐to‐edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge‐to‐edge repair. Methods and Results We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge‐to‐edge repair. The end points were all‐cause mortality and a composite of mortality and heart failure hospitalization at 2 years. Using the receiver operating characteristic curve–derived threshold of 0.6 for pulmonary effective arterial elastance ([Ea], pulmonary artery systolic pressure/stroke volume), patients were stratified into 3 profiles based on PH severity (low elastance [HE]: Ea <0.6/mean pulmonary artery pressure (mPAP)) <35; High Elastance with No/Mild PH (HE−): Ea ≥0.6/mPAP <35; and HE with Moderate/Severe PH (HE+): Ea ≥0.6/mPAP ≥35) and MR pathogenesis (Primary MR [PMR])/low elastance, PMR/HE, and secondary MR). The association between this classification and clinical outcomes was examined using Cox regression. Among 114 patients included, 50.9% had PMR. Mean±SD age was 74.7±10.6 years. Patients with Ea ≥0.6 were more likely to have diabetes, atrial fibrillation, New York Heart Association III/IV status, and secondary MR (all P<0.05). Overall, 2‐year cumulative survival was 71.1% and was lower in patients with secondary MR and mPAP ≥35. Compared with patients with low elastance, cumulative 2‐year event‐free survival was significantly lower in HE− and HE+ patients (85.5% versus 50.4% versus 41.0%, respectively, P=0.001). Also, cumulative 2‐year event‐free survival was significantly higher in patients with PMR/low elastance when compared with PMR/HE and patients with secondary mitral regurgitation (85.5% versus 55.5% versus 46.1%, respectively, P=0.005). Conclusions Assessment of the preprocedural cardiopulmonary profile based on mPAP, MR pathogenesis, and Ea guides patient selection by identifying hemodynamic features that indicate likely benefit from mitral‐transcatheter edge‐to‐edge repair in PH or lack thereof.https://www.ahajournals.org/doi/10.1161/JAHA.123.033510mitral regurgitationmitral transcatheter edge‐to‐edge repairpulmonary effective arterial elastancepulmonary hypertensionright ventricular afterload |
| spellingShingle | Rody G. Bou Chaaya Taha Hatab Sahar Samimi Fatima Qamar Chloe Kharsa Joe Aoun Nadeen Faza Stephen H. Little Marvin D. Atkins Michael J. Reardon Neal S. Kleiman Sherif F. Nagueh William A. Zoghbi Ashrith Guha Syed Zaid Sachin S. Goel Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease mitral regurgitation mitral transcatheter edge‐to‐edge repair pulmonary effective arterial elastance pulmonary hypertension right ventricular afterload |
| title | Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair |
| title_full | Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair |
| title_fullStr | Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair |
| title_full_unstemmed | Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair |
| title_short | Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge‐to‐Edge Repair |
| title_sort | prognostic value of right ventricular afterload in patients undergoing mitral transcatheter edge to edge repair |
| topic | mitral regurgitation mitral transcatheter edge‐to‐edge repair pulmonary effective arterial elastance pulmonary hypertension right ventricular afterload |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033510 |
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