Change in Invasively Measured Mean Pulmonary Artery Pressure After Transcatheter Mitral Valve Repair Is Associated With Heart Failure Readmission

David M. Tehrani, Jiexi Wang, Parntip Lai, Pooja S. Desai, Heajung L. Nguyen, Lisa Bang, Eric H. Yang, Gabriel Vorobiof, Ali Nsair, Olcay Aksoy, Marcella Calfon Press, Rushi V. Parikh

Abstract


Background: Pre-existing pulmonary hypertension is associated with poor outcomes after transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR). However, the impact of an immediate change in mean pulmonary artery pressure (delta mPAP) following TMVr on outcomes is unknown.

Methods: Patients who underwent TMVr from December 2015 to February 18, 2020 at our institution for symptomatic 3-4+ MR and who had invasive hemodynamics measured immediately pre- and post-TMVR were included. Multivariate Cox regression analysis was performed to examine the association of delta mPAP (post-TMVr - pre-TMVr mPAP) with the primary endpoint of heart failure (HF) readmission at 1 year. Secondary endpoints included all-cause mortality and the composite endpoint of HF readmission or all-cause mortality at 1 year.

Results: Among 55 patients, 55% were men, mean age was 72 ± 14.2 years, and mean delta mPAP was -1.4 ± 8.2 mm Hg. Overall, HF readmission occurred in 14 (25%), death in 10 (18%), and the composite endpoint in 20 (36%) patients. In multivariable analyses, higher delta mPAP was significantly associated with HF readmission (hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00 - 1.21; P = 0.04). delta mPAP was not associated with death (HR = 1.04, 95% CI: 0.96 - 1.14; P = 0.33), though there was a numerical but statistically non-significant trend towards the composite endpoint (HR = 1.06, 95% CI: 1.00 - 1.13; P = 0.06) driven by HF readmission.

Conclusion: Higher delta mPAP immediately following TMVr was associated with increased HF readmission at 1 year. Larger prospective studies are needed to validate these data and further explore the utility of delta mPAP as a novel hemodynamic parameter to predict post-TMVR outcomes.




Cardiol Res. 2021;12(5):302-308
doi: https://doi.org/10.14740/cr1284

Keywords


Mitral regurgitation; MitraClip; Heart failure readmission; Mortality

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