Key result
Disproportionate secondary MR fails to independently predict 2-year major cardiovascular events.
Why the study?
The prognostic role of echocardiographic parameters assessing secondary mitral regurgitation severity and left ventricular dimension, including proportionate versus disproportionate SMR, in MitraClip recipients remained to be evaluated.
Does disproportionate secondary mitral regurgitation predict the composite of cardiovascular mortality and heart failure hospitalisation in patients undergoing edge-to-edge percutaneous mitral valve repair?
Observational (n=137)
Yes
Does disproportionate secondary mitral regurgitation predict the composite of cardiovascular mortality and heart failure hospitalisation in patients undergoing edge-to-edge percutaneous mitral valve repair?
In patients undergoing MitraClip for secondary mitral regurgitation, the EROA/LVEDV ratio (proportionate vs disproportionate SMR) does not independently predict 2-year clinical outcomes, whereas baseline clinical risk and residual MR do.
Disproportionate SMR should not yet guide MitraClip selection; leaves open EROA thresholds for residual MR risk.
AIMS: The aim of this study was to evaluate the prognostic role of echocardiographic parameters assessing secondary mitral regurgitation (SMR) severity and left ventricular dimension, including proportionate versus disproportionate SMR, in MitraClip recipients. METHODS AND RESULTS: We analysed 137 patients undergoing MitraClip implantation for SMR at three centres. SMR was classified as proportionate or disproportionate based on the median value of the ratio between effective regurgitant orifice area (EROA) and left ventricular end-diastolic volume (LVEDV). The primary endpoint was a composite of cardiovascular mortality and heart failure hospitalisation at two-year follow-up. Mean age was 70±10 years, 80% were male, and median EuroSCORE II was 5.7%. No differences were observed in the disproportionate compared to the proportionate group except for a more severe NYHA class and their expected higher EROA and lower LVEDV. Number of clips deployed, device success and procedural success were similar between the two groups. Residual mitral regurgitation (MR) >1+ at 30 days was more common among patients with an EROA >0.42 cm2 compared to those with an EROA ≤0.42 cm2 (81.3% vs 58%; p=0.004). The relative risk of the primary endpoint was independent from any echocardiographic parameter, including the presence of disproportionate SMR. The only independent predictors of clinical events were EuroSCORE II >8%, NYHA class and residual MR >1+ at 30 days. CONCLUSIONS: Echocardiographic parameters, including the EROA/LVEDV ratio, do not have independent prognostic value in patients undergoing MitraClip implantation. High surgical risk, advanced symptoms and non-optimal MR reduction increase the relative risk of two-year clinical events.
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Adamo et al. (2020) conducted an observational in Secondary mitral regurgitation (n=137). MitraClip implantation vs. Proportionate vs disproportionate SMR was evaluated on Composite of cardiovascular mortality and heart failure hospitalisation at two-year follow-up. Disproportionate secondary mitral regurgitation did not independently predict 2-year clinical events, whereas residual MR >1+ at 30 days was higher with EROA >0.42 cm2 (81.3% vs 58%; p=0.004).
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