Key result
Concomitant pulmonary limitations in patients undergoing transcatheter mitral valve repair were associated with significantly higher 2-year all-cause mortality (31.4% vs 21.4%, p=0.018).
Why the study?
Patients with pulmonary disease and symptomatic mitral regurgitation share symptoms such as dyspnea and reduced exercise capacity, but the impact of underlying pulmonary limitations on outcomes after TMVr was unclear.
Does concomitant pulmonary disease affect clinical outcomes and symptom relief after TMVr in patients with symptomatic mitral regurgitation?
Cohort (n=483)
No
Does concomitant pulmonary disease affect clinical outcomes and symptom relief after TMVr in patients with symptomatic mitral regurgitation?
Patients with concomitant pulmonary disease experience similar symptom relief and reduction in hospitalizations after TMVr compared to those without, but have significantly higher 2-year all-cause mortality.
OBJECTIVES: We investigated the impact of underlying pulmonary limitations (PL) on symptoms and clinical outcomes after transcatheter mitral valve repair (TMVr). BACKGROUND: Patients with pulmonary disease and patients with symptomatic mitral regurgitation (MR) suffer common symptoms like dyspnea and reduced exercise capacity. METHODS: Datasets from the TMVr Ulm registry were retrospectively analyzed by a blinded specialist in pneumology. Patients were dichotomized according to an unambiguous manifestation of concomitant pulmonary disease in a PL-group and a non-PL-group and were analyzed regarding baseline characteristics and clinical follow-up. RESULTS: Overall, 483 patients were included in the study of which 32.3% (n = 156) showed an underlying pulmonary disease. Patients in the PL-group were similar to patients in the non-PL-group, including Euro SCORE II (8.2 vs. 8.4, p = 0.39), New York Heart Association (NYHA) classification (3.2 ± 0.7 in both groups, p = 0.65) and the incidence of moderate-to-severe or severe MR after TMVr (5.8 vs. 8.3%, p = 0.32). Equal and significant symptom relief after TMVr was experienced in both cohorts according to NYHA functional class (2.24 ± 0.84 vs. 2.24 ± 0.86, p = 0.93) and rate of hospitalization during 2 years of follow-up decreased comparably from 61.1 to 19.3%. However, all-cause mortality for 2 year follow-up was significantly higher in the PL-group compared to the non-PL-group (31.4 vs. 21.4%, p = 0.018). CONCLUSION: In patients with MR and concomitant pulmonary disorders, a significant increase of exercise capacity and a significant decrease of rehospitalization rate were observed after TMVr. Nevertheless, all-cause mortality remains significantly increased within a follow-up period of 2 years compared to patients without pulmonary disorders.
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Schneider et al. (2021) conducted a cohort in Symptomatic mitral regurgitation (n=483). Concomitant pulmonary limitations vs. No pulmonary limitations was evaluated on All-cause mortality at 2 years (p=0.018). Concomitant pulmonary limitations in patients undergoing transcatheter mitral valve repair were associated with significantly higher 2-year all-cause mortality (31.4% vs 21.4%, p=0.018).
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