Key result
Baseline MR in TAVI is linked to ~19% higher mortality but is not an independent predictor.
Why the study?
Mitral regurgitation is the most common valvular lesion in TAVI recipients, but its long-term prognostic impact required assessment.
Does baseline mitral regurgitation worsen long-term prognosis (mortality, stroke, HF rehospitalization) in adult patients undergoing TAVI?
Cohort
Yes
Does baseline mitral regurgitation worsen long-term prognosis (mortality, stroke, HF rehospitalization) in adult patients undergoing TAVI?
Effect estimate: HR 1.192 (95% CI 1.125-1.263)
In patients undergoing TAVI, baseline mitral regurgitation is associated with increased crude rates of mortality and HF rehospitalization, but serves as an independent predictor only for HF rehospitalization.
Baseline MR should not alter TAVI decisions; leaves open whether it independently extends mortality prediction beyond confounders.
Mitral regurgitation (MR) is the most common valvular lesion in transcatheter aortic valve implantation (TAVI) recipients. This study aims to assess the long-term prognostic impact of baseline MR in TAVI patients. METHODS: Adult patients who underwent TAVI were identified in the French National Hospital Discharge Database. All-cause and cardiovascular mortality, stroke, and rehospitalization with heart failure (HF) were compared in TAVI patients with and without baseline MR and tricuspid regurgitation (TR), respectively; the associations of MR and TR with the outcomes were assessed by Cox regression. RESULTS: Baseline MR was identified in 8240 TAVI patients. Patients with baseline MR have higher yearly incidence of all-cause mortality (HR: 1.192, 95% confidence interval CI: 1.125-1.263), cardiovascular mortality (HR: 1.313, 95%CI: 1.210-1.425), and rehospitalization for heart failure (HF) (HR: 1.411, 95%CI: 1.340-1.486) compared to those without, except for stroke rate (HR: 0.988, 95%CI: 0.868-1.124). Neither baseline MR nor TR was an independent risk predictor for all-cause mortality or cardiovascular mortality in TAVI patients. Baseline MR was independently associated with rehospitalization for HF in TAVI patients. CONCLUSIONS: Baseline MR and TR were associated with increased all-cause and cardiovascular mortality post-TAVI, however, neither of them was independent predictor for all-cause or cardiovascular mortality.
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Zhang et al. (2021) conducted a cohort in Transcatheter Aortic Valve Implantation (TAVI). Baseline mitral regurgitation vs. No baseline mitral regurgitation was evaluated on All-cause mortality (HR 1.192, 95% CI 1.125-1.263). Baseline mitral regurgitation in TAVI patients was associated with higher all-cause mortality (HR 1.192; 95% CI 1.125-1.263), though it was not an independent predictor of mortality.
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