Scholarlink

Background <p>Pulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.</p> Aims <p>To evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.</p> Methods <p>A total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.</p> Results <p>Overall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38&#xa0;months, time to HFH 74 vs. 44&#xa0;months, and time to composite endpoint 49 vs. 26&#xa0;months, all <i>p</i> &lt; 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58&#xa0;months, <i>p</i> = 0.027; time to HFH 74&#xa0;months, <i>p</i> = 0.004; time to composite endpoint 50&#xa0;months, <i>p</i> = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.</p> Conclusion <p>Assessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. Its combination with the post-procedural level of MR can easily identify patients at low or high risk of subsequent adverse outcomes.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Impact of pulmonary hypertension dynamics and residual mitral regurgitation shortly after M-TEER on long-term outcomes: insights from a prospective registry

  • 期刊论文

  • 发表日期：

    2025年9月8日

查看全文
  • Miroslav Hudec,
  • Jaroslav Januska,
  • Otakar Jiravsky,
  • Roman Miklik,
  • Martin Urban,
  • Miloslav Dorda,
  • Alica Cesnakova Konecna,
  • Libor Gajdusek,
  • Ivan Ranic,
  • David Vician,
  • Radim Spacek,
  • Bogna Jiravska Godula,
  • Libor Sknouril,
  • Petr Kala

摘要

Background

Pulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.

Aims

To evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.

Methods

A total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.

Results

Overall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38 months, time to HFH 74 vs. 44 months, and time to composite endpoint 49 vs. 26 months, all p < 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58 months, p = 0.027; time to HFH 74 months, p = 0.004; time to composite endpoint 50 months, p = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.

Conclusion

Assessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. Its combination with the post-procedural level of MR can easily identify patients at low or high risk of subsequent adverse outcomes.

Graphical Abstract