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Predictors of functional recovery after mitral transcatheter-edge-to-edge repair
Session:
Comunicações Orais (Sessão 21) - Intervenção Cardíaca Coronária e Estrutural 3 - Vários Tópicos
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diogo Santos Ferreira; Cláudio Guerreiro; Gualter Silva; Ana Rita Moura; Silvia Diaz; Eulália Pereira; Francisco Sampaio; Fábio Nunes; Rafael Teixeira; Lino Santos; Alberto Rodrigues; Pedro Braga; Gustavo Pires de Morais; Bruno Melica; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND:</strong> Mitral regurgitation (MR) is now the second-most frequent valvular heart disease in Europe, and can significantly impair functional performance, which can be easily assessed using New York Heart Association (NYHA) heart failure classification. Mitral transcatheter-edge-to-edge repair (TEER) is an increasingly attractive solution has a rather minimal-invasive approach to reduce MR, symptoms and, in some cases, prognostic, in eligible patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> A single-centre retrospective database of all consecutive TEER procedures for primary and secondary MR performed between May 2014 and November 2020 was analyzed. The primary outcome was defined as a reduction of NYHA class of at least 1 point one month after treatment, and the secondary outcome considered a reduction of at least 2 classes. Clinical, echocardiographic and blood-analysis data previous to TEER were explored as potential predictors of good NYHA response, using Pearson’s Chi-squared test, Wilcoxon rank sum test and Fisher’s exact test, as appropriate. A p<0.05 was considered statistically significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS:</strong> A total of 86 cases had complete information regarding NYHA status both prior and 1 month after TEER (image 1). 60% of the patients improved at least one NYHA class, and both age and sex seem not to have influenced this response. On the other hand, a higher body surface area was associated with functional recovery. Interestingly, a lower N-terminal pro-brain natriuretic peptide (NTproBNP) at baseline was linked to a higher response after intervention (2048 versus 5676pg/ml, p<0.001). However, there were no differences regarding existing cardiovascular risk factors, atrial fibrillation and chronic obstructive pulmonary disease between NYHA responders and non-responders. The same scenario was found regarding echocardiographic data, namely for ejection fraction (EF), severity of mitral and tricuspid regurgitation, right ventricular function and left atrial size. There was a tendency for higher predicted surgical risk assessed through EuroSCORE II to be associated with a positive response after treatment, which did not reach statistical significance (p=0.068). Only 13% cases exhibited a NYHA improvement of at least 2 functional classes, and these also had lower NTproBNP basal levels (p=0.006) and tended to have lower inferior vena cava (IVC) diameter (10 versus 23mm, p=0.039) and estimated systolic pulmonary artery pressure (sPAP, 39 versus 56mmHg, p=0.041).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS: </strong>According to the present study, only three-fifths of cases improved their NYHA class after mitral TEER. These data suggest that patients treated during earlier signs of disease – with lower NTproBNP levels, less severe pulmonary hypertension, and lower IVC diameters – are associated with a more clinical benefit from intervention, though these are merely exploratory deductions of a relatively low number, single-centre, patients.</span></span></p>
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