Key result
A lower MAP/RAP ratio was independently associated with an increased risk of the combined primary endpoint of all-cause mortality or heart failure hospitalization (OR 0.75) in patients undergoing successful transcatheter mitral valve repair.
Why the study?
Optimal patient selection for transcatheter mitral valve repair remains difficult, making further predictors of outcome after successful repair important to identify.
Does the MAP/RAP ratio predict the composite of all-cause mortality or heart failure hospitalization in patients with congestive heart failure and severe mitral regurgitation after successful transcatheter mitral valve repair?
Cohort (n=145)
No
Does the MAP/RAP ratio predict the composite of all-cause mortality or heart failure hospitalization in patients with congestive heart failure and severe mitral regurgitation after successful transcatheter mitral valve repair?
Odds Ratio: 0.75 (95% CI 0.62–0.9)
Absolute Event Rate: 62.2% vs 39.4%
p-value: p=0.002
The MAP/RAP ratio is an independent predictor of mortality and heart failure hospitalization after successful transcatheter mitral valve repair, with a lower ratio indicating worse outcomes.
Lower MAP/RAP ratio may aid post-TMVR risk stratification; leaves open prospective validation before clinical use.
BACKGROUND: It is important to identify further predictors of outcome after successful transcatheter mitral valve repair (TMVR), as optimal patient selection remains difficult. OBJECTIVE: The study investigates the prognostic benefit of the mean arterial pressure (MAP) to right atrial pressure (RAP) ratio (MAP/RAP ratio) after successful TMVR in patients with congestive heart failure (CHF) and severe mitral regurgitation (MR). METHOD: Patients with CHF and severe MR were enrolled after successful TMVR (MR ≤ 2+ at discharge). The primary endpoint was a composite of all-cause mortality or hospitalisation for heart failure. The median follow-up time was 16 ± 9 months. Receiver Operating Characteristic (ROC) analysis was applied to assess the discriminatory power of the MAP/RAP ratio. The predictive value of the MAP/RAP ratio threshold was investigated using a Kaplan-Meier analysis. Multivariable logistic regression analysis was conducted to evaluate independent risk factors for the combined primary endpoint. RESULTS: 145 patients (median age 76 [69-80 years], 60.3% male) were included. ROC curve analysis showed that MAP/RAP ratio was associated with an area under the curve of 0.62 (95% confidence interval (CI) 0.53-0.71; p = 0.01). A MAP/RAP ratio threshold of 7.13 was associated with 67.4% sensitivity and 57.0% specificity for the combined primary endpoint. Event-free survival was significantly lower in the MAP/RAP ratio < 7.13 group compared to those with MAP/RAP ratio ≥ 7.13 (62.2% versus 39.4%; log-rank p = 0.022). In logistic regression analysis MAP/RAP ratio was an independent predictor for the combined primary endpoint (odds ratio 0.75; 95% CI 0.62-0.90; p = 0.002). CONCLUSIONS: The MAP/RAP ratio is associated with an unfavorable outcome in patients undergoing successful TMVR. Therefore, this new index could improve prognostic assessment of TMVR candidates.
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Osteresch et al. (2021) conducted a cohort in Congestive heart failure and severe functional mitral regurgitation (n=145). MAP/RAP ratio vs. Higher MAP/RAP ratio was evaluated on Composite of all-cause mortality or hospitalisation for heart failure (OR 0.75, 95% CI 0.62-0.90, p=0.002). A lower MAP/RAP ratio was independently associated with an increased risk of the combined primary endpoint of all-cause mortality or heart failure hospitalization (OR 0.75) in patients undergoing successful transcatheter mitral valve repair.
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