Deceleration capacity of heart rate predicts 1‐year mortality in patients undergoing transcatheter edge‐to‐edge mitral valve repair

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 46; no. 5; pp. 529 - 534
• Main Authors: Mizera, Lars, Rath, Dominik, Schreieck, Jürgen, Seizer, Peter, Gawaz, Meinrad Paul, Duckheim, Martin, Eick, Christian, Müller, Karin A. L.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-05-2023; John Wiley and Sons Inc
• Subjects: Beta blockers; Cardiac arrhythmia; cardiac autonomic dysfunction; Cardiac Catheterization - adverse effects; Cardiovascular disease; Clinical Investigations; Coronary vessels; Creatinine; Deceleration; deceleration capacity; Diabetes; Diuretics; Ejection fraction; Electrocardiography; Gender; Heart Rate; Heart Valve Prosthesis Implantation - methods; Hemoglobin; Humans; Hypertension; Kidney diseases; Laboratories; Leukocytes; MitraClip; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - surgery; Mortality; Pulmonary arteries; Regression analysis; Retrospective Studies; Sinuses; Survival analysis; Treatment Outcome; Variables; Vein & artery diseases; New York; United States > US; mortality; MitraClip; deceleration capacity; cardiac autonomic dysfunction
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24007

Background
Risk stratification for transcatheter procedures in patients with severe mitral regurgitation is challenging. Deceleration capacity (DC) has already proven to be a reliable risk predictor in patients undergoing transcatheter aortic valve implantation. We hypothesized, that DC provides prognostic value in patients undergoing transcatheter edge‐to‐edge mitral valve repair (TEER).
Methods
We retrospectively analyzed electrocardiogram signals from 106 patients undergoing TEER at the University Hospital of Tübingen. All patients received continuous heart‐rate monitoring to assess DC following the procedure. One‐year all‐cause mortality was defined as the primary end point.
Results
Sixteen patients (15.1%) died within 1 year. The DC in nonsurvivors was significantly reduced compared to survivors (5.1 ± 3.0 vs. 3.0 ± 1.6 ms, p = 0.002). A higher EuroSCORE II and impaired left ventricular function were furthermore associated with poor outcome. In Cox regression analyses, a DC < 4.5 ms was found a strong predictor of 1‐year mortality (hazard ratio: 0.10, 95% confidence interval: 0.13–0.79, p = 0.029). Finally, a significant negative correlation was found between DC and residual mitral regurgitation after TEER (r = −0.41, p < 0.001).
Conclusion
In patients with severe mitral regurgitation undergoing TEER, DC may serve as a new predictor of follow‐up mortality.
In patients with severe mitral regurgitation undergoing transcatheter edge‐to‐edge mitral valve repair, deceleration capacity (DC) may serve as a new predictor of follow‐up mortality.