Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Worsens Survival in Patients with Renal Dysfunction

Figures

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  Figure 1. Cumulative incidence curves of 3-year mortality for glomerular filtration rate (GFR) < 30 ml/min per 1.73 m2, 30-50 mL/min per 1.73 m2, and > 50 mL/min per 1.73 m2. Cumulative incidence curve for 3-year mortality in patients with (red line) GFR < 30 mL/min per 1.73 m2, (blue line) 30-50 mL/min per1.73 m2, and (green line) > 50 mL/min per 1.73 m2. GFR values are given in mL/min per 1.73 m2.

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  Figure 2. Association of residual mitral regurgitation (MR) and baseline renal function. The MitraScore is a multimodal score to evaluate residual MR following mitral TEER. (A) Percentage of patients with (green) mild (MitraScore [MS] ≤ 3) or (orange) relevant residual MR (MitraScore ≥ 4) in patients with glomerular filtration rate (GFR) < 30 mL/min per 1.73 m2, 30-50 mL/min per 1.73 m2, and > 50 mL/min/1.73 m2. (B) 3-year mortality stratified by residual MR assessed by MS and GFR group. Orange bars indicate MS ≥ 4 and green bars indicate MS ≤ 3 post transcatheter edge-to-edge repair (TEER) in GFR < 30 mL/min per 1.73 m2, 30-50 mL/min per 1.73 m2, and > 50 mL/min per 1.73 m2. (C) Distribution of New York Heart Association (NYHA) stages according to MS in GFR < 30 mL/min per 1.73 m2, 30-50 mL/min per 1.73 m2, and > 50 mL/min per 1.73 m2. FU, follow up.

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  Figure 3. Cumulative incidence curves of 3-year mortality according to residual mitral regurgitation (MR) for glomerular filtration rate (GFR) < 30 mL/min per 1.73 m2, 30-50 ml/min per 1.73 m2, and > 50 mL/min per 1.73 m2. Cumulative incidence curve for 3-year mortality according to residual MR assessed by MitraScore (MS) in patients with GFR < 30 mL/min per 1.73 m2 (blue line: MS ≤ 3; red line: MS ≥ 4), 30-50 mL/min per 1.73 m2 (magenta line: MS ≤ 3; yellow line: MS ≥ 4) and > 50 mL/min per 1.73 m2 (light blue line: MS ≤ 3; green line: MS ≥ 4). GFR in figure is given in units of mL/min per 1.73 m2. The MitraScore is a multimodal score to evaluate residual MR following mitral TEER.

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  Figure 4. Postprocedural acute kidney injury and mitral transcatheter edge-to-edge repair (TEER). (A) Mean change in hemodynamic parameters from baseline (preprocedure) to postprocedure (post) following TEER. (B) Number of TEER devices with or without acute kidney injury (AKI). (C) Distribution of New York Heart Association (NYHA) stages at baseline and 12-months follow-up (FU) in patients with vs without postprocedural AKI. (D) Cumulative incidence curves of patients with vs without postprocedural AKI. MitraScore is a multimodal score to assess MR during mitral TEER. It is evaluated prior and post the procedure and a reduction in MR is indicated by a lower MitraScore. CVP, central venous pressure; LVEDP, left ventricular end-diastolic-pressure; MPG, mean mitral valve pressure gradient; RR, blood pressure.

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  Figure 5. Cumulative incidence curves of 3-year mortality according to residual mitral regurgitation for patients with vs without postprocedural acute kidney injury (AKI). Cumulative incidence curve for 3-year mortality according to residual mitral regurgitation assessed by MitraScore (MS) in patients without AKI (yellow line, no AKI; MS ≤ 3; green line, and MS ≥ 4) vs with AKI (blue line, MS ≤ 3 and red line, MS ≥ 4). The MitraScore is a multimodal score to evaluate residual MR following mitral TEER. A MitraScore ≤ 3 means mild residual MR, while a MitraScore ≥ 4 means relevant residual MR.