Usefulness of Age (≥85 Years) and Residual Mitral Regurgitation (>1+/4+) for the Prediction of Adverse Outcomes in Patients Receiving the MitraClip

• Published in: The American journal of cardiology Vol. 124; no. 9; pp. 1449 - 1453
• Main Authors: Chen, Wei, Berke, Andrew, Chung, William, Koss, Elena, Gopal, Aarsha, Cao, Jie Jane, Wang, Lin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2019
• Subjects: Age Factors; Aged; Aged, 80 and over; Female; Heart Diseases - mortality; Heart Failure - epidemiology; Humans; Male; Mitral Valve Annuloplasty; Mitral Valve Insufficiency - surgery; Mortality; Multivariate Analysis; Patient Readmission - statistics & numerical data; Prognosis; Proportional Hazards Models; Pulmonary Wedge Pressure; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke Volume; Surgical Instruments; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.07.038

The goal of this study was to determine the predictors of adverse clinical outcomes in patients treated with the MitraClip for significant mitral regurgitation (MR) with a focus on acute changes in hemodynamics and cardiac function. This retrospective study included 63 patients (mean age 82 ± 8 years, 48% male) with moderate to severe or severe MR. Cardiac catheterization was performed before and immediately after MitraClip repair. Volumetric and functional changes were assessed in both ventricles. A major adverse cardiac event was defined as a composite of cardiac death and readmission for heart failure. Patients were followed up on average for 380 days. MR was improved in 92% of patients after MitraClip therapy from an average grade of 4+ to <2+ (p <0.001). The pulmonary capillary wedge pressure decreased from 22 ± 7 mm Hg to 19 ± 6 mm Hg (p <0.001), and the cardiac stroke volume increased by 28% from 102 ± 53 ml to 131 ± 54 ml (p <0.001). The left ventricular end-diastolic volume was significantly reduced 24 hours after MitraClip therapy compared to that at baseline (p = 0.001). In the multivariate Cox proportion hazard regression model, an age ≥85 years (p <0.001) and residual MR >1+ (p <0.048) were predictors of an adverse prognosis at follow-up. In conclusion, a reduced left ventricular end-diastolic volume and improved hemodynamics occurred early after MitraClip therapy. An advanced age (≥85 years) and residual MR >1+ were associated with an increased risk of mortality and heart failure.