Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment
The prognostic predictors of outcome in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation (MCi) are still poorly known. The aim of our study is to identify the baseline predictors of outcome in FMR patients candidate to MCi. All patients with symptomatic moderate-...
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| Veröffentlicht in: | International journal of cardiology 2019-06, Vol.284, p.50-58 |
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| creator | Baldi, Cesare Citro, Rodolfo Silverio, Angelo Di Maio, Marco De Rosa, Roberta Bonadies, Domenico Verolino, Giuseppe Esposito, Luca Mastrogiovanni, Generoso Di Muro, Michele Roberto Piscione, Federico Galasso, Gennaro |
| description | The prognostic predictors of outcome in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation (MCi) are still poorly known. The aim of our study is to identify the baseline predictors of outcome in FMR patients candidate to MCi.
All patients with symptomatic moderate-to-severe or severe FMR undergoing MCi at our institution were consecutively and prospectively enrolled. Baseline clinical and instrumental data were collected. Primary endpoint was the occurrence of cardiac death; secondary endpoints were all-cause death and the composite of cardiac death or rehospitalization for heart failure.
74 patients (mean 71.6 ± 8.3 years) were enrolled. During follow-up (median 416.0 days), the primary endpoint occurred in 15 (20.3%), all-cause death in 26 (35.1%) and the composite endpoint in 25 (33.8%). At multivariate analysis, the left atrial volume index (LAVi; HR:1.02; P = 0.048) and the low peak oxygen uptake (peak VO2; HR:0.73; P = 0.018) increased the risk of cardiac death at follow-up; atrial fibrillation (AF; HR:2.69; P = 0.027) was independently associated to all-cause death and the low level of peak VO2 was an independent predictor of overall mortality (HR:0.70; P |
| doi_str_mv | 10.1016/j.ijcard.2018.10.055 |
| format | Article |
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All patients with symptomatic moderate-to-severe or severe FMR undergoing MCi at our institution were consecutively and prospectively enrolled. Baseline clinical and instrumental data were collected. Primary endpoint was the occurrence of cardiac death; secondary endpoints were all-cause death and the composite of cardiac death or rehospitalization for heart failure.
74 patients (mean 71.6 ± 8.3 years) were enrolled. During follow-up (median 416.0 days), the primary endpoint occurred in 15 (20.3%), all-cause death in 26 (35.1%) and the composite endpoint in 25 (33.8%). At multivariate analysis, the left atrial volume index (LAVi; HR:1.02; P = 0.048) and the low peak oxygen uptake (peak VO2; HR:0.73; P = 0.018) increased the risk of cardiac death at follow-up; atrial fibrillation (AF; HR:2.69; P = 0.027) was independently associated to all-cause death and the low level of peak VO2 was an independent predictor of overall mortality (HR:0.70; P < 0.001) as well as of the composite endpoint (HR:0.73; P < 0.001).
The ROC analysis identified a peak VO2 cut-off of 10.0 mL/kg/min as the best predictor for the three study endpoints; the best LAVi cut-off for cardiac death was 67 mL/m2. Kaplan-Meier analysis for the individual and combined outcome predictors confirmed their significant stratification ability during follow-up.
Peak VO2, along with LAVi and AF, identify FMR patients with the worst prognosis after MCi.
•The MCi eligibility of FMR patients needs a multiparametric evaluation to avoid futility.•Baseline peak VO2, LAVi and AF are independent predictors of events after MCi.•In FMR patients peak VO2 < 10 mL/kg/min carried the worst prognosis after MCi.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2018.10.055</identifier><identifier>PMID: 30360995</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Atrial fibrillation ; Cardiopulmonary exercise test ; Disease Progression ; Echocardiography ; Female ; Follow-Up Studies ; Functional mitral regurgitation ; Heart failure ; Heart Failure - complications ; Heart Failure - epidemiology ; Heart Failure - physiopathology ; Heart Valve Prosthesis Implantation - methods ; Humans ; Incidence ; Italy - epidemiology ; Male ; MitraClip ; Mitral Valve - diagnostic imaging ; Mitral Valve - surgery ; Mitral Valve Insufficiency - diagnosis ; Mitral Valve Insufficiency - etiology ; Mitral Valve Insufficiency - surgery ; Percutaneous mitral valve repair ; Prognosis ; Prospective Studies ; Prosthesis Design ; Risk Assessment - methods ; Risk Factors ; Severity of Illness Index ; Survival Rate - trends ; Treatment Outcome ; Ventricular Function, Left - physiology</subject><ispartof>International journal of cardiology, 2019-06, Vol.284, p.50-58</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-72d92908e34b648df4f6a263157b85d2b9137b3577cc0af7dbfe9b829a30a74d3</citedby><cites>FETCH-LOGICAL-c362t-72d92908e34b648df4f6a263157b85d2b9137b3577cc0af7dbfe9b829a30a74d3</cites><orcidid>0000-0003-3622-4965</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijcard.2018.10.055$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30360995$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baldi, Cesare</creatorcontrib><creatorcontrib>Citro, Rodolfo</creatorcontrib><creatorcontrib>Silverio, Angelo</creatorcontrib><creatorcontrib>Di Maio, Marco</creatorcontrib><creatorcontrib>De Rosa, Roberta</creatorcontrib><creatorcontrib>Bonadies, Domenico</creatorcontrib><creatorcontrib>Verolino, Giuseppe</creatorcontrib><creatorcontrib>Esposito, Luca</creatorcontrib><creatorcontrib>Mastrogiovanni, Generoso</creatorcontrib><creatorcontrib>Di Muro, Michele Roberto</creatorcontrib><creatorcontrib>Piscione, Federico</creatorcontrib><creatorcontrib>Galasso, Gennaro</creatorcontrib><title>Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>The prognostic predictors of outcome in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation (MCi) are still poorly known. The aim of our study is to identify the baseline predictors of outcome in FMR patients candidate to MCi.
All patients with symptomatic moderate-to-severe or severe FMR undergoing MCi at our institution were consecutively and prospectively enrolled. Baseline clinical and instrumental data were collected. Primary endpoint was the occurrence of cardiac death; secondary endpoints were all-cause death and the composite of cardiac death or rehospitalization for heart failure.
74 patients (mean 71.6 ± 8.3 years) were enrolled. During follow-up (median 416.0 days), the primary endpoint occurred in 15 (20.3%), all-cause death in 26 (35.1%) and the composite endpoint in 25 (33.8%). At multivariate analysis, the left atrial volume index (LAVi; HR:1.02; P = 0.048) and the low peak oxygen uptake (peak VO2; HR:0.73; P = 0.018) increased the risk of cardiac death at follow-up; atrial fibrillation (AF; HR:2.69; P = 0.027) was independently associated to all-cause death and the low level of peak VO2 was an independent predictor of overall mortality (HR:0.70; P < 0.001) as well as of the composite endpoint (HR:0.73; P < 0.001).
The ROC analysis identified a peak VO2 cut-off of 10.0 mL/kg/min as the best predictor for the three study endpoints; the best LAVi cut-off for cardiac death was 67 mL/m2. Kaplan-Meier analysis for the individual and combined outcome predictors confirmed their significant stratification ability during follow-up.
Peak VO2, along with LAVi and AF, identify FMR patients with the worst prognosis after MCi.
•The MCi eligibility of FMR patients needs a multiparametric evaluation to avoid futility.•Baseline peak VO2, LAVi and AF are independent predictors of events after MCi.•In FMR patients peak VO2 < 10 mL/kg/min carried the worst prognosis after MCi.</description><subject>Aged</subject><subject>Atrial fibrillation</subject><subject>Cardiopulmonary exercise test</subject><subject>Disease Progression</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Functional mitral regurgitation</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>MitraClip</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Mitral Valve - surgery</subject><subject>Mitral Valve Insufficiency - diagnosis</subject><subject>Mitral Valve Insufficiency - etiology</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Percutaneous mitral valve repair</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Prosthesis Design</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Survival Rate - trends</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left - physiology</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1v1DAQhi0EotuWf4CQj1yy9Vfi-FIJrQpUKoIDPVuOPd56lcSL7RTBr8fRthx7GumdZ2Y0D0LvKdlSQrurwzYcrEluywjta7QlbfsKbWgvRUNlK16jTcVk0zLJz9B5zgdCiFCqf4vOOOEdUardoL8_ErhgS0wZR4_jUmycAIcZP4BJBXsTxiUBPpoSYC4Z_w7lAWd4hBr6ZbYlxNmMeAol1ZJgv6R9KGaN8TI7SPsY5j3-tvZ3YzjiksCUqe66RG-8GTO8e6oX6P7zzc_d1-bu-5fb3ae7xvKOlUYyp5giPXAxdKJ3XvjOsI7TVg5969igKJcDb6W0lhgv3eBBDT1ThhMjheMX6ONp7zHFXwvkoqeQLYyjmSEuWTPKOkUJF6Si4oTaFHNO4PUxhcmkP5oSvVrXB32yrlfra1qt17EPTxeWYQL3f-hZcwWuTwDUPx8DJJ1t1Wmr-gS2aBfDyxf-AS_KmBQ</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Baldi, Cesare</creator><creator>Citro, Rodolfo</creator><creator>Silverio, Angelo</creator><creator>Di Maio, Marco</creator><creator>De Rosa, Roberta</creator><creator>Bonadies, Domenico</creator><creator>Verolino, Giuseppe</creator><creator>Esposito, Luca</creator><creator>Mastrogiovanni, Generoso</creator><creator>Di Muro, Michele Roberto</creator><creator>Piscione, Federico</creator><creator>Galasso, Gennaro</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3622-4965</orcidid></search><sort><creationdate>20190601</creationdate><title>Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment</title><author>Baldi, Cesare ; Citro, Rodolfo ; Silverio, Angelo ; Di Maio, Marco ; De Rosa, Roberta ; Bonadies, Domenico ; Verolino, Giuseppe ; Esposito, Luca ; Mastrogiovanni, Generoso ; Di Muro, Michele Roberto ; Piscione, Federico ; Galasso, Gennaro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-72d92908e34b648df4f6a263157b85d2b9137b3577cc0af7dbfe9b829a30a74d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>Cardiopulmonary exercise test</topic><topic>Disease Progression</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Functional mitral regurgitation</topic><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>Incidence</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>MitraClip</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Mitral Valve - surgery</topic><topic>Mitral Valve Insufficiency - diagnosis</topic><topic>Mitral Valve Insufficiency - etiology</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Percutaneous mitral valve repair</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Prosthesis Design</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Survival Rate - trends</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baldi, Cesare</creatorcontrib><creatorcontrib>Citro, Rodolfo</creatorcontrib><creatorcontrib>Silverio, Angelo</creatorcontrib><creatorcontrib>Di Maio, Marco</creatorcontrib><creatorcontrib>De Rosa, Roberta</creatorcontrib><creatorcontrib>Bonadies, Domenico</creatorcontrib><creatorcontrib>Verolino, Giuseppe</creatorcontrib><creatorcontrib>Esposito, Luca</creatorcontrib><creatorcontrib>Mastrogiovanni, Generoso</creatorcontrib><creatorcontrib>Di Muro, Michele Roberto</creatorcontrib><creatorcontrib>Piscione, Federico</creatorcontrib><creatorcontrib>Galasso, Gennaro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baldi, Cesare</au><au>Citro, Rodolfo</au><au>Silverio, Angelo</au><au>Di Maio, Marco</au><au>De Rosa, Roberta</au><au>Bonadies, Domenico</au><au>Verolino, Giuseppe</au><au>Esposito, Luca</au><au>Mastrogiovanni, Generoso</au><au>Di Muro, Michele Roberto</au><au>Piscione, Federico</au><au>Galasso, Gennaro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>284</volume><spage>50</spage><epage>58</epage><pages>50-58</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><abstract>The prognostic predictors of outcome in patients with functional mitral regurgitation (FMR) undergoing MitraClip implantation (MCi) are still poorly known. The aim of our study is to identify the baseline predictors of outcome in FMR patients candidate to MCi.
All patients with symptomatic moderate-to-severe or severe FMR undergoing MCi at our institution were consecutively and prospectively enrolled. Baseline clinical and instrumental data were collected. Primary endpoint was the occurrence of cardiac death; secondary endpoints were all-cause death and the composite of cardiac death or rehospitalization for heart failure.
74 patients (mean 71.6 ± 8.3 years) were enrolled. During follow-up (median 416.0 days), the primary endpoint occurred in 15 (20.3%), all-cause death in 26 (35.1%) and the composite endpoint in 25 (33.8%). At multivariate analysis, the left atrial volume index (LAVi; HR:1.02; P = 0.048) and the low peak oxygen uptake (peak VO2; HR:0.73; P = 0.018) increased the risk of cardiac death at follow-up; atrial fibrillation (AF; HR:2.69; P = 0.027) was independently associated to all-cause death and the low level of peak VO2 was an independent predictor of overall mortality (HR:0.70; P < 0.001) as well as of the composite endpoint (HR:0.73; P < 0.001).
The ROC analysis identified a peak VO2 cut-off of 10.0 mL/kg/min as the best predictor for the three study endpoints; the best LAVi cut-off for cardiac death was 67 mL/m2. Kaplan-Meier analysis for the individual and combined outcome predictors confirmed their significant stratification ability during follow-up.
Peak VO2, along with LAVi and AF, identify FMR patients with the worst prognosis after MCi.
•The MCi eligibility of FMR patients needs a multiparametric evaluation to avoid futility.•Baseline peak VO2, LAVi and AF are independent predictors of events after MCi.•In FMR patients peak VO2 < 10 mL/kg/min carried the worst prognosis after MCi.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>30360995</pmid><doi>10.1016/j.ijcard.2018.10.055</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3622-4965</orcidid></addata></record> |
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| subjects | Aged Atrial fibrillation Cardiopulmonary exercise test Disease Progression Echocardiography Female Follow-Up Studies Functional mitral regurgitation Heart failure Heart Failure - complications Heart Failure - epidemiology Heart Failure - physiopathology Heart Valve Prosthesis Implantation - methods Humans Incidence Italy - epidemiology Male MitraClip Mitral Valve - diagnostic imaging Mitral Valve - surgery Mitral Valve Insufficiency - diagnosis Mitral Valve Insufficiency - etiology Mitral Valve Insufficiency - surgery Percutaneous mitral valve repair Prognosis Prospective Studies Prosthesis Design Risk Assessment - methods Risk Factors Severity of Illness Index Survival Rate - trends Treatment Outcome Ventricular Function, Left - physiology |
| title | Predictors of outcome in heart failure patients with severe functional mitral regurgitation undergoing MitraClip treatment |
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