Key result
Higher quality of life at 30 days post-procedure, assessed by the KCCQ-12 score, was a significant predictor of a reduced 1-year risk of all-cause mortality or heart failure hospitalization (HR 0.98).
Why the study?
Data were limited regarding the association between quality of life and clinical outcomes after transcatheter mitral valve repair.
Cohort (n=555)
No
Quality of life assessment using the KCCQ at 30 days following transcatheter mitral valve repair is a strong prognostic indicator for 1-year mortality and heart failure hospitalization, even among patients with procedural success.
Background. Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to characterize those who had procedural success, yet reported a low Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score. Methods. We reported the experience of Cedars-Sinai Medical Center patients between 2013 and 2020. Patients were allocated into four groups according to the 30-day KCCQ: <25, 25–49, 50–74, and ≥75. Primary outcome included 1-year all-cause death or heart failure (HF) hospitalizations. We also examined the association between QoL and the primary outcome in those with procedural success. Results. A total of 555 patients were included in our analysis, median follow-up of 650 days (IQR 243–1113). The lower KCCQ groups had a higher prevalence of functional mitral regurgitation (65%, 60%, 56%, and 43%, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>p</a:mi> <a:mo>=</a:mo> <a:mn>0.001</a:mn> </a:math> ), as well as a higher Society of Thoracic Surgeon (STS) score. These groups had a significantly higher occurrence of 1-year all-cause death or HF hospitalizations in a stepwise fashion (40%, 22%, 16%, and 10%, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>p</c:mi> <c:mo><</c:mo> <c:mn>0.001</c:mn> </c:math> ). Multivariable Cox regression analysis revealed 30-day KCCQ as the strongest predictor of the 1-year primary outcome (HR 0.98, 95%CI (0.97–0.99), <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo>=</e:mo> <e:mn>0.006</e:mn> </e:math> ). Approximately a quarter of patients with procedural success had a low KCCQ score. These patients had a higher rate of the combined 1-year outcome regardless of procedural success or failure. Conclusion. QoL following TMVr is a powerful prognostic factor. KCCQ assessment is an important indicator for identifying patients prone to adverse outcomes even after procedural success.
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Natanzon et al. (2023) conducted a cohort in Mitral Regurgitation (n=555). 30-day Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score vs. Lower KCCQ score strata was evaluated on 1-year all-cause death or heart failure (HF) hospitalizations (HR 0.98, 95% CI 0.97-0.99, p=0.006). Higher quality of life at 30 days post-procedure, assessed by the KCCQ-12 score, was a significant predictor of a reduced 1-year risk of all-cause mortality or heart failure hospitalization (HR 0.98).
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