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Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions ( TRAMI ) registry
Author(s) -
Tigges Eike,
Blankenberg Stefan,
von Bardeleben R. Stephan,
Zürn Christine,
Bekeredjian Raffi,
Ouarrak Taoufik,
Sievert Horst,
Nickenig Georg,
Boekstegers Peter,
Senges Jochen,
Schillinger Wolfgang,
Lubos Edith
Publication year - 2018
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.864
Subject(s) - mitraclip , medicine , cardiology , pulmonary hypertension , pulmonary artery , heart failure , mitral valve , mitral regurgitation , myocardial infarction
Aims We sought to evaluate the impact of pulmonary hypertension on outcomes following MitraClip therapy. Methods and results The 643 patients in the TRAnscatheter Mitral valve Interventions ( TRAMI ) registry were divided into three groups according to echocardiographically graded systolic pulmonary artery pressure ( sPAP ) (Group 1: patients with sPAP of ≤36 mmHg ; Group 2: patients with sPAP of 37–50 mmHg ; Group 3: patients with sPAP of >50 mmHg ) and followed for 1 year. Recent cardiac decompensation, aortic valve disease and tricuspid valve insufficiency were observed more frequently in patients with higher sPAP . Furthermore, logEuroSCORE , Society of Thoracic Surgeons score and age were higher with rising sPAP values. No differences were observed in mitral regurgitation ( MR ) severity, co‐morbidities or clinical findings (New York Heart Association class, 6‐min walking distance). Reduction to MR of grade 1 or lower was achieved more often in patients with lower sPAP levels ( P = 0.01). In Groups 2 and 3, sPAP was reduced significantly. Major adverse cardiac or cardiovascular events ( MACCEs ) occurring in hospital (death, myocardial infarction, stroke; <4% in each group), as well as 30‐day rates of MACCEs (6.1% in Group 1, 11.9% in Group 2, 12.4% in Group 3) and rehospitalization (18.9% in Group 1, 24.8% in Group 2, 24.8% in Group 3) did not differ significantly. At 1 year, differences in rates of mortality and MACCEs (20.3% in Group 1, 33.1% in Group 2, 34.7% in Group 3; P < 0.01) were significant. Both Groups 2 [hazard ratio ( HR ) 1.81, P = 0.0122] and 3 ( HR 1.85, P = 0.0092) were independently predictive of death. Rehospitalization rates did not differ during follow‐up. Conclusions Despite higher mortality in patients with elevated sPAP , these data suggest the safety, feasibility and benefit of MitraClip therapy even in advanced stages of disease. An early approach might prevent the progress of pulmonary hypertension and improve outcomes.