Key result
MitraClip is linked to ~14 mmHg sPAP reduction in severe PH but higher sPAP without PH.
Why the study?
The study evaluated the impact of MitraClip on systolic pulmonary artery pressure and the effects of baseline systolic pulmonary artery pressure on outcomes.
Does MitraClip implantation improve systolic pulmonary artery pressure in patients with varying degrees of baseline pulmonary hypertension?
Cohort (n=177)
Does MitraClip implantation improve systolic pulmonary artery pressure in patients with varying degrees of baseline pulmonary hypertension?
p-value: p=<0.001
MitraClip implantation effectively reduces systolic pulmonary artery pressure in patients with severe baseline pulmonary hypertension, but paradoxically increases it in a majority of those without baseline pulmonary hypertension.
sPAP reduction in severe PHT but rise without PHT with similar survival; hypothesis-generating, should not yet change practice.
AIMS: We evaluated the impact of MitraClip on systolic pulmonary artery pressure (sPAP) and the effects of baseline sPAP on outcomes. METHODS AND RESULTS: In a cohort of patients who underwent MitraClip implantation, three groups were defined according to pre-procedure sPAP levels. Clinical and echocardiographic data were compared. The study included 177 patients: 59 had severe pulmonary hypertension (PHT), 96 had mild to moderate PHT, and 22 had no PHT. In patients with pre-existing severe PHT, sPAP was reduced from 70.8 ± 9.2 to 56.8 ± 13.7 mmHg (P < 0.001), sPAP remained unchanged in patients with mild to moderate PHT but was significantly increased from 30.8 ± 4.3 to 38.6 ± 8.3 mmHg in the no-PHT group (P < 0.001). Improvement of sPAP was observed in 77% of severe PHT group, while worsening of sPAP was more common among patients with no-PHT [57% compared with 33% among the mild to moderate PHT and 7% in the severe PHT group, respectively, (P < 0.001)]. One year survival was similar among the study groups. CONCLUSIONS: MitraClip decreases PHT among patients with severe PHT. A concerning finding is that most patients with no-PHT increase their sPAP.
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Rashi et al. (2020) conducted a cohort in Patients undergoing MitraClip implantation (n=177). MitraClip implantation vs. Baseline sPAP groups (severe, mild to moderate, no pulmonary hypertension) was evaluated on Change in systolic pulmonary artery pressure (sPAP) (p=<0.001). MitraClip implantation reduced systolic pulmonary artery pressure in severe pulmonary hypertension (70.8 to 56.8 mmHg, P<0.001) but increased it in patients without pulmonary hypertension.
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