Key result
Patients undergoing transcatheter mitral valve repair experienced similar 1-year survival free of severe heart failure symptoms regardless of baseline left atrial pressure <18 mmHg or ≥18 mmHg (58.7% vs 66.0%; P=0.33).
Why the study?
Patients with low left atrial pressure undergoing transcatheter mitral valve repair have a high incidence of chronic lung disease, and it is unknown whether they symptomatically benefit from repair.
Does baseline left atrial pressure affect symptomatic improvement and mortality following transcatheter mitral valve repair in patients with severe mitral regurgitation?
Cohort (n=302)
Does baseline left atrial pressure affect symptomatic improvement and mortality following transcatheter mitral valve repair in patients with severe mitral regurgitation?
Absolute Event Rate: 58.7% vs 66%
p-value: p=0.33
Transcatheter mitral valve repair provides similar symptomatic improvement and 1-year survival in patients with severe mitral regurgitation regardless of whether baseline left atrial pressure is low or high.
Background Prior studies have demonstrated that patients with low left atrial pressure (LAP) undergoing transcatheter mitral valve repair (TMVr) have a high incidence of chronic lung disease, and it is unknown whether they symptomatically benefit from repair. The goal of this study was to compare the degree of symptomatic improvement following TMVr in patients according to baseline LAP. Methods We retrospectively reviewed patients who underwent TMVr with continuous LAP monitoring from May 1, 2014 to January 14, 2020. Patients were grouped according to mean LAP below (group 1) or above (group 2) the median (< or ≥ 18 mmHg, respectively) and symptoms were assessed by New York Heart Association (NYHA) functional class. One-year mortality and symptomatic improvement were compared between groups. Results In 302 patients, age, sex, left ventricular ejection fraction and mitral regurgitation severity were similar between groups. Patients in group 2 had larger left atrial volume index (73.0 ± 32.2 cc/m 2 vs. 67.0 ± 26.0 cc/m 2 , p = 0.008) and higher baseline mean NYHA class compared to group 1 (3.2 ± 0.5 vs. 3.0 ± 0.6, p = 0.003), but both had significant improvements in NYHA at 1-month (1.9 ± 0.9 vs. 1.8 ± 0.8, both p < 0.0001) and 12-months (1.9 ± 0.8 vs. 2.2 ± 0.9, both p < 0.0001). The predicted one-year survival free of severe class 3 or 4 heart failure symptoms was also similar (58.7% vs. 66.0%, p = 0.33) and there was no difference in estimated one-year survival between groups (77.5% vs. 72.7%, p = 0.89). Conclusion Patients with severe mitral regurgitation experience a similar symptomatic improvement following TMVr regardless of baseline LAP.
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Breen et al. (2021) conducted a cohort in Severe mitral regurgitation (n=302). Baseline mean left atrial pressure < 18 mmHg vs. Baseline mean left atrial pressure ≥ 18 mmHg was evaluated on Predicted one-year survival free of severe class 3 or 4 heart failure symptoms (p=0.33). Patients undergoing transcatheter mitral valve repair experienced similar 1-year survival free of severe heart failure symptoms regardless of baseline left atrial pressure <18 mmHg or ≥18 mmHg (58.7% vs 66.0%; P=0.33).
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