Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 5, October 2021, pages 302-308

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

Figure 1. Immediate change in invasively measured mPAP after TMVr. Patients free from HF readmission (a) and those with a HF readmission (b) at 1 year are depicted with their immediate pre- and post-TMVr mPAP after undergoing TMVr. HF: heart failure; mPAP: mean pulmonary artery pressure; TMVr: transcatheter mitral valve repair.

**Table 1.** Baseline Clinical, Echocardiographic, and Procedural Characteristics
	N = 55
Data are presented as mean ± standard deviation or frequency (percentage) as appropriate. ^aProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^bΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. LA: left atrium; LVEF: left ventricular ejection fraction; LVIDD: left ventricular internal diameter end-diastolic; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; PASP: pulmonary artery systolic pressure; TAPSE: tricuspid annular plane systolic excursion; TMVr: transcatheter mitral valve repair.
Clinical characteristics
Age (years)	72 ± 14.2
Male sex	30 (55%)
Race
White	25 (46%)
Hispanic	14 (26%)
African American	7 (13%)
Asian	8 (15%)
End-stage renal disease	5 (9%)
Chronic lung disease	10 (20%)
Cardiovascular demographics
Hypertension	43 (78%)
Diabetes	17 (31%)
Coronary artery disease	14 (26%)
Atrial fibrillation	26 (47%)
Stroke	8 (15%)
Current smoker	7 (13%)
Peripheral artery disease	5 (9%)
Echocardiographic characteristics
MR etiology
Degenerative	35 (64%)
Functional	18 (33%)
Mixed	2 (4%)
MR severity
3+ (moderate-severe)	9 (16%)
4+ (severe)	83.6 (46%)
Tricuspid regurgitation (baseline)
Moderate-severe	3 (6%)
Severe	5 (9%)
TAPSE (cm)	1.8 ± 0.4
PASP (mm Hg)	47.6 ± 15.7
LVEF (%)	44.8 ± 18.6
LVIDD (cm)	5.83 ± 1.1
LA volume indexed (mL/m²)	77.6 ± 55.6
Procedural characteristics
Procedural success^a	50 (91%)
Improvement in MR grade	2.3 ± 0.84
Number of MitraClips	1.65 ± 0.76
Post-TMVr mitral gradient	3.94 ± 1.42
Pre-TMVr mPAP (mm Hg)	31.5 ± 10.1
Post-TMVr mPAP (mm Hg)	30.1 ± 7.4
ΔmPAP (mm Hg)^b	1.4 ± 8.2

Table 1. Baseline Clinical, Echocardiographic, and Procedural Characteristics

N = 55

Data are presented as mean ± standard deviation or frequency (percentage) as appropriate. ^aProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^bΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. LA: left atrium; LVEF: left ventricular ejection fraction; LVIDD: left ventricular internal diameter end-diastolic; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; PASP: pulmonary artery systolic pressure; TAPSE: tricuspid annular plane systolic excursion; TMVr: transcatheter mitral valve repair.

Clinical characteristics

Age (years)

72 ± 14.2

Male sex

30 (55%)

Race

White

25 (46%)

Hispanic

14 (26%)

African American

7 (13%)

Asian

8 (15%)

End-stage renal disease

5 (9%)

Chronic lung disease

10 (20%)

Cardiovascular demographics

Hypertension

43 (78%)

Diabetes

17 (31%)

Coronary artery disease

14 (26%)

Atrial fibrillation

26 (47%)

Stroke

8 (15%)

Current smoker

7 (13%)

Peripheral artery disease

5 (9%)

Echocardiographic characteristics

MR etiology

Degenerative

35 (64%)

Functional

18 (33%)

Mixed

2 (4%)

MR severity

3+ (moderate-severe)

9 (16%)

4+ (severe)

83.6 (46%)

Tricuspid regurgitation (baseline)

Moderate-severe

3 (6%)

Severe

5 (9%)

TAPSE (cm)

1.8 ± 0.4

PASP (mm Hg)

47.6 ± 15.7

LVEF (%)

44.8 ± 18.6

LVIDD (cm)

5.83 ± 1.1

LA volume indexed (mL/m²)

77.6 ± 55.6

Procedural characteristics

Procedural success^a

50 (91%)

Improvement in MR grade

2.3 ± 0.84

Number of MitraClips

1.65 ± 0.76

Post-TMVr mitral gradient

3.94 ± 1.42

Pre-TMVr mPAP (mm Hg)

31.5 ± 10.1

Post-TMVr mPAP (mm Hg)

30.1 ± 7.4

ΔmPAP (mm Hg)^b

1.4 ± 8.2

**Table 2.** Association of Clinical and Procedural Characteristics With Heart Failure Readmission at 1 Year
	Univariable analysis	Multivariable analysis^a
^aCovariates significant at a P < 0.10 in univariable analysis were included in multivariable analysis. ^bProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^cΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. AA: African American; CAD: coronary artery disease; CI: confidence interval; CVA: cerebrovascular accident; ESRD: end-stage renal disease; HR: hazard ratio; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; TMVr: transcatheter mitral valve repair.
Age (years)	0.98	0.95 - 1.02	0.30
Male sex	0.55	0.19 - 1.62	0.28
White race	1.24	0.43 - 3.53	0.69
AA race	1.95	0.54 - 7.00	0.31
Hispanic race	1.05	0.37 - 3.01	0.92
Hypertension	0.51	0.17 - 1.52	0.23
Diabetes	2.00	0.69 - 5.78	0.20
CAD	0.24	0.03 - 1.85	0.17
ESRD	1.57	0.35 - 7.02	0.55
Chronic lung disease	1.54	0.48 - 4.91	0.47
Atrial fibrillation	0.09	0.11 - 1.16	0.09	0.41	0.13 - 1.33	0.14
CVA	0.38	0.05 - 2.93	0.36
Peripheral artery disease	0.61	0.08 - 4.66	0.63
Current smoker	1.38	0.31 - 6.18	0.67
Degenerative MR	1.83	0.51 - 6.55	0.36
Functional MR	0.55	0.15 - 1.96	0.36
Procedural success^b	1.39	0.18 - 10.62	0.75
Post-TMVr mitral gradient	0.92	0.66 - 1.29	0.64
ΔmPAP (mm Hg)^c	1.10	1.01 - 1.19	0.03	1.10	1.00 - 1.21	0.04

Table 2. Association of Clinical and Procedural Characteristics With Heart Failure Readmission at 1 Year

Univariable analysis

Multivariable analysis^a

95% CI

P-value

95% CI

P-value

^aCovariates significant at a P < 0.10 in univariable analysis were included in multivariable analysis. ^bProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^cΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. AA: African American; CAD: coronary artery disease; CI: confidence interval; CVA: cerebrovascular accident; ESRD: end-stage renal disease; HR: hazard ratio; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; TMVr: transcatheter mitral valve repair.

Age (years)

0.98

0.95 - 1.02

0.30

Male sex

0.55

0.19 - 1.62

0.28

White race

1.24

0.43 - 3.53

0.69

AA race

1.95

0.54 - 7.00

0.31

Hispanic race

1.05

0.37 - 3.01

0.92

Hypertension

0.51

0.17 - 1.52

0.23

Diabetes

2.00

0.69 - 5.78

0.20

CAD

0.24

0.03 - 1.85

0.17

ESRD

1.57

0.35 - 7.02

0.55

Chronic lung disease

1.54

0.48 - 4.91

0.47

Atrial fibrillation

0.09

0.11 - 1.16

0.09

0.41

0.13 - 1.33

0.14

CVA

0.38

0.05 - 2.93

0.36

Peripheral artery disease

0.61

0.08 - 4.66

0.63

Current smoker

1.38

0.31 - 6.18

0.67

Degenerative MR

1.83

0.51 - 6.55

0.36

Functional MR

0.55

0.15 - 1.96

0.36

Procedural success^b

1.39

0.18 - 10.62

0.75

Post-TMVr mitral gradient

0.92

0.66 - 1.29

0.64

ΔmPAP (mm Hg)^c

1.10

1.01 - 1.19

0.03

1.10

1.00 - 1.21

0.04

**Table 3.** Association of Clinical and Procedural Characteristics With All-Cause Mortality at 1 Year
	Univariable analysis
^aProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^bΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. AA: African American; CAD: coronary artery disease; CI: confidence interval; CVA: cerebrovascular accident; ESRD: end-stage renal disease; HR: hazard ratio; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; TMVr: transcatheter mitral valve repair.
Age (years)	1.01	0.96 - 1.06	0.70
Male sex	0.34	0.09 - 1.31	0.12
White race	1.17	0.34 - 4.04	0.81
AA race	0.73	0.09 - 5.75	0.76
Hispanic race	0.67	0.16 - 2.89	0.60
Hypertension	3.01	0.39 - 24.23	0.29
Diabetes	1.12	0.29 - 4.32	0.87
CAD	0.84	0.18 - 3.95	0.82
ESRD	0.96	0.12 - 7.62	0.97
Chronic lung disease	0.92	0.20 - 4.32	0.91
Atrial fibrillation	1.16	0.34 - 4.01	0.81
CVA	0.04	0.00 - 67.28	0.39
Peripheral artery disease	0.96	0.12 - 7.62	0.97
Current smoker	0.84	0.11 - 6.62	0.87
Degenerative MR	4.52	0.57 - 35.65	0.15
Functional MR	0.15	0.03 - 1.75	0.49
Procedural success^a	0.11	0.03 - 0.41	< 0.01
Post-TMVr mitral gradient	1.16	0.79 - 1.72	0.45
ΔmPAP (mm Hg)^b	1.04	0.96 - 1.14	0.33

Table 3. Association of Clinical and Procedural Characteristics With All-Cause Mortality at 1 Year

Univariable analysis

95% CI

P-value

^aProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^bΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. AA: African American; CAD: coronary artery disease; CI: confidence interval; CVA: cerebrovascular accident; ESRD: end-stage renal disease; HR: hazard ratio; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; TMVr: transcatheter mitral valve repair.

Age (years)

1.01

0.96 - 1.06

0.70

Male sex

0.34

0.09 - 1.31

0.12

White race

1.17

0.34 - 4.04

0.81

AA race

0.73

0.09 - 5.75

0.76

Hispanic race

0.67

0.16 - 2.89

0.60

Hypertension

3.01

0.39 - 24.23

0.29

Diabetes

1.12

0.29 - 4.32

0.87

CAD

0.84

0.18 - 3.95

0.82

ESRD

0.96

0.12 - 7.62

0.97

Chronic lung disease

0.92

0.20 - 4.32

0.91

Atrial fibrillation

1.16

0.34 - 4.01

0.81

CVA

0.04

0.00 - 67.28

0.39

Peripheral artery disease

0.96

0.12 - 7.62

0.97

Current smoker

0.84

0.11 - 6.62

0.87

Degenerative MR

4.52

0.57 - 35.65

0.15

Functional MR

0.15

0.03 - 1.75

0.49

Procedural success^a

0.11

0.03 - 0.41

< 0.01

Post-TMVr mitral gradient

1.16

0.79 - 1.72

0.45

ΔmPAP (mm Hg)^b

1.04

0.96 - 1.14

0.33

**Table 4.** Association of Clinical and Procedural Characteristics With Heart Failure Readmission or All-Cause Mortality at 1 Year
	Univariable analysis	Multivariable analysis^a
^aCovariates significant at a P < 0.10 in univariable analysis were included in multivariable analysis. ^bProcedural success was defined as a ≥ 2+ MR improvement from pre-TMVr to post-TMVr. ^cΔmPAP was defined as the difference in the post-mitral TMVr mPAP and the pre-mitral TMVr mPAP. AA: African American; CAD: coronary artery disease; CI: confidence interval; CVA: cerebrovascular accident; ESRD: end-stage renal disease; HR: hazard ratio; mPAP: mean pulmonary artery pressure; MR: mitral regurgitation; TMVr: transcatheter mitral valve repair.
Age (years)	0.99	0.96 - 1.01	0.32
Male sex	0.51	0.21 - 1.26	0.15
White race	1.21	0.51 - 2.92	0.67
AA race	1.72	0.57 - 5.15	0.33
Hispanic race	0.69	0.25 - 1.93	0.48
Hypertension	0.67	0.26 - 1.74	0.41
Diabetes	1.40	0.56 - 3.52	0.47
CAD	0.54	0.16 - 1.85	0.33
ESRD	1.03	0.24 - 4.48	0.96
Chronic lung disease	0.94	0.31 - 2.82	0.92
Atrial fibrillation	0.51	0.20 - 1.29	0.16
CVA	0.26	0.03 - 1.92	0.19
Peripheral artery disease	0.41	0.06 - 3.07	0.39
Current smoker	1.41	0.41 - 4.82	0.58
Degenerative MR	2.05	0.69 - 6.14	0.19
Functional MR	0.49	0.16 - 1.46	0.20
Procedural success^b	0.35	0.12 - 1.07	0.07	0.37	0.12 - 1.11	0.08
Post-TMVr mitral gradient	0.97	0.73 - 1.28	0.83
ΔmPAP (mm Hg)^c	1.06	1.00 - 1.13	0.06	1.06	1.00 - 1.13	0.06

Table 4. Association of Clinical and Procedural Characteristics With Heart Failure Readmission or All-Cause Mortality at 1 Year

Univariable analysis

Multivariable analysis^a

95% CI

P-value

95% CI

P-value

Age (years)

0.99

0.96 - 1.01

0.32

Male sex

0.51

0.21 - 1.26

0.15

White race

1.21

0.51 - 2.92

0.67

AA race

1.72

0.57 - 5.15

0.33

Hispanic race

0.69

0.25 - 1.93

0.48

Hypertension

0.67

0.26 - 1.74

0.41

Diabetes

1.40

0.56 - 3.52

0.47

CAD

0.54

0.16 - 1.85

0.33

ESRD

1.03

0.24 - 4.48

0.96

Chronic lung disease

0.94

0.31 - 2.82

0.92

Atrial fibrillation

0.51

0.20 - 1.29

0.16

CVA

0.26

0.03 - 1.92

0.19

Peripheral artery disease

0.41

0.06 - 3.07

0.39

Current smoker

1.41

0.41 - 4.82

0.58

Degenerative MR

2.05

0.69 - 6.14

0.19

Functional MR

0.49

0.16 - 1.46

0.20

Procedural success^b

0.35

0.12 - 1.07

0.07

0.37

0.12 - 1.11

0.08

Post-TMVr mitral gradient

0.97

0.73 - 1.28

0.83

ΔmPAP (mm Hg)^c

1.06

1.00 - 1.13

0.06

1.06

1.00 - 1.13

0.06