Atrial fibrillation was associated with a higher risk of 2-year all-cause mortality after M-TEER in patients with degenerative mitral regurgitation (adjusted HR 1.88; 95% CI 1.17-3.02; P=0.009).
Cohort (n=3,764)
Does atrial fibrillation increase the risk of all-cause mortality in patients undergoing mitral transcatheter edge-to-edge repair across different mitral regurgitation etiologies?
Atrial fibrillation is associated with increased all-cause mortality after M-TEER in patients with degenerative mitral regurgitation, but not in those with ventricular or atrial functional mitral regurgitation.
Effect estimate: adjusted HR 1.88 (95% CI 1.17-3.02)
p-value: p=0.009
BACKGROUND: The association between atrial fibrillation (AF) and prognosis after mitral transcatheter edge-to-edge repair (M-TEER) remains unclear. OBJECTIVES: The authors examined the association between AF and clinical outcomes after M-TEER according to the etiology of mitral regurgitation (MR). METHODS: A total of 3,764 patients were classified into degenerative mitral regurgitation (DMR), ventricular functional mitral regurgitation (VFMR), and atrial functional mitral regurgitation (AFMR). We further stratified the patients by the presence of AF. The primary outcome was all-cause mortality within 2 years. RESULTS: The prevalence of AF was 57.4% (n = 646 of 1,126) in DMR, 59.7% (n = 1,319 of 2,211) in VFMR, and 83.8% (n = 358 of 427) in AFMR. During 2-year follow-up (the median follow-up: 427 IQR: 301-821 days), 660 of 3,764 patients (17.5%) died. The association between AF and all-cause mortality had a significant interaction with MR etiology (P for interaction <0.001). AF was associated with a higher risk of all-cause mortality in DMR (adjusted HR: 1.88; 95% CI: 1.17-3.02; P = 0.009), whereas this association was not significant in VFMR and AFMR. Among patients with VFMR, left atrial (LA) volume index modified the association between AF and all-cause mortality. AF was related to a higher risk of all-cause mortality in VFMR patients with lower LA volume index, whereas this association was attenuated in those with higher LA volume index. CONCLUSIONS: AF was associated with all-cause mortality after M-TEER in patients with DMR, but not in those with VFMR or AFMR. The prognostic effect of AF in patients undergoing M-TEER may be modulated by MR etiology and underlying LA remodeling.
Tanaka et al. (Fri,) conducted a cohort in Mitral regurgitation undergoing M-TEER (n=3,764). Atrial fibrillation vs. No atrial fibrillation was evaluated on All-cause mortality within 2 years (adjusted HR 1.88, 95% CI 1.17-3.02, p=0.009). Atrial fibrillation was associated with a higher risk of 2-year all-cause mortality after M-TEER in patients with degenerative mitral regurgitation (adjusted HR 1.88; 95% CI 1.17-3.02; P=0.009).