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The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri‐interventional dynamics
Author(s) -
Öztürk Can,
Sprenger Kim,
Tabata Noriaki,
Sugiura Atsushi,
Weber Marcel,
Nickenig Georg,
Schueler Robert
Publication year - 2021
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.15126
Subject(s) - mitraclip , medicine , mitral regurgitation , cardiology , interquartile range , predictive value , mitral valve , surgery
Abstract Background The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri‐interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip. Methods We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6 months. 12‐month survival was documented. Results One hundred and seventy five patients (age 81.2 ± 8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5 mm Hg, determined by a multivariate analysis of predictors for 12‐month mortality (<4.5 mm Hg: Group 1, ≥4.5 mm Hg: Group 2). Intraprocedural MG ≥4.5 mm Hg was found to be the strongest independent predictor for 12‐month mortality (HR: 2.33, P = .03, OR: 1.70, P = .05), and >3.9 mm Hg was associated with adverse functional outcomes (OR: 1.96, P = .04). The baseline leaflet‐to‐annulus index >1.1 was found to be the strongest independent predictor (OR: 9.74, P = .001) for unfavorable intraprocedural MG, followed by the number of implanted clips ( P = .01), MG at baseline ( P = .02), and central clip implantation ( P = .05). Conclusion An intraprocedural MG <3.9 mm Hg appears to be the best strategy for 1‐year survival and favorable functional outcomes after edge‐to‐edge MV repair with MitraClip independently from MR etiology. Peri‐interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.