Key result
Right ventricular dysfunction is linked to ~12-fold higher 1-year mortality in heart failure.
Why the study?
The prognostic accuracy of the SHFM and MAGGIC score in patients undergoing MitraClip with or without right ventricular dysfunction had not been investigated.
Does right ventricular dysfunction and heart failure risk scores (SHFM, MAGGIC) predict one-year mortality in patients with severe mitral regurgitation undergoing MitraClip?
Cohort (n=103)
No
Does right ventricular dysfunction and heart failure risk scores (SHFM, MAGGIC) predict one-year mortality in patients with severe mitral regurgitation undergoing MitraClip?
Right ventricular dysfunction is a crucial prognostic marker for MitraClip patients, and the SHFM score demonstrates stronger predictive accuracy than the MAGGIC score in patients with preserved right ventricular function.
RVD was associated with higher post-MitraClip mortality; hypothesis-generating for SHFM over MAGGIC in preserved RV function, needing prospective validation.
BACKGROUND: MitraClip ® (MC) is an established procedure for severe mitral regurgitation (MR) in patients deemed unsuitable for surgery.Right ventricular dysfunction (RVD) is associated with a higher mortality risk. The prognostic accuracy of heart failure risk scores like the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in pts undergoing MC with or without RVD has not been investigated so far. METHODS: SHFM and MAGGIC score were calculated retrospectively. RVD was determined as tricuspid annular plane systolic excursion (TAPSE) ≤15 mm. Area under receiver operating curves (AUROC) of SHFM and MAGGIC were performed for one-year all-cause mortality after MC. RESULTS: N = 103 pts with MR III° (73 ± 11 years, LVEF 37 ± 17%) underwent MC with a reduction of at least I° MR. One-year mortality was 28.2%.In Kaplan-Meier analysis, one- year mortality was significantly higher in RVD-pts (34.8% vs 2.8%, p = 0.009).Area under the Receiver Operating Characteristic (AUROC) for SHFM and MAGGIC were comparable for both scores (SHFM: 0.704, MAGGIC: 0.692). In pts without RVD, SHFM displayed a higher AUROC and therefore better diagnostic accuracy (SHFM: 0.776; MAGGIC: 0.551, p < 0.05). In pts with RVD, MAGGIC and SHFM displayed comparable AUROCs. CONCLUSION: RVD is an important prognostic marker in pts undergoing MC. SHFM and MAGGIC displayed adequate over-all prognostic power in these pts. Accuracy differed in pts with and without RVD, indicating higher predictive power of the SHFM score in pts without RVD.
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Heyl et al. (2020) conducted a cohort in Severe mitral regurgitation (MR III°) deemed unsuitable for surgery (n=103). Right ventricular dysfunction (TAPSE ≤15 mm) vs. Preserved right ventricular function (TAPSE >15 mm) was evaluated on One-year all-cause mortality (p=0.009). Right ventricular dysfunction significantly increased one-year mortality (34.8% vs 2.8%, p=0.009), while the SHFM score provided better prognostic accuracy than MAGGIC in patients without RVD.
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