Impact of heart failure hospitalizations on clinical outcomes after mitral transcatheter edge-to-edge repair: Results from the EXPAND study.

Autor: Kessler M; Ulm University Heart Center, University of Ulm, Ulm, Germany., Rottbauer W; Ulm University Heart Center, University of Ulm, Ulm, Germany., von Bardeleben RS; University Medical Center of Johannes Gutenberg University, Mainz, Germany., Grasso C; Ferrarotto Hospital, University of Catania, Catania, Italy., Lurz P; University Medical Center of Johannes Gutenberg University, Mainz, Germany., Mahoney P; Heart Center Leipzig - University Hospital, Leipzig, Germany., Price M; Scripps Clinic, La Jolla, CA, USA., Williams M; Heart Valve Center, New York University Langone Health, New York, NY, USA., Denti P; San Raffaele University Hospital, Milan, Italy., Estevez-Loureiro R; Hospital Alvaro Cunqueiro, Vigo, Pontevedra, Spain., Kar S; Los Robles Regional Medical Center, HCA Healthcare, Thousand Oaks, CA, USA., Maisano F; San Raffaele University Hospital, Milan, Italy.
Jazyk: angličtina
Zdroj: European journal of heart failure [Eur J Heart Fail] 2024 Jul; Vol. 26 (7), pp. 1495-1503. Date of Electronic Publication: 2024 May 10.
DOI: 10.1002/ejhf.3250
Abstrakt: Aim: This analysis aimed to compare the clinical outcomes associated with heart failure (HF) readmissions and to identify associations with HF hospitalizations (HFH) in patients treated with the MitraClip™ NTR/XTR System in the EXPAND study.
Methods and Results: The global, real-world EXPAND study enrolled 1041 patients with primary or secondary mitral regurgitation (MR) treated with the MitraClip NTR/XTR System. Echocardiograms were analysed by an independent echocardiographic core laboratory. The study population was stratified into HFH and No-HFH groups based on the occurrence of HFH 1 year post-index procedure. Clinical outcomes including MR severity, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and all-cause mortality were compared (HFH: n = 181; No-HFH: n = 860). Both groups achieved consistent 1-year MR reduction to ≤1+ (HFH vs. No-HFH: 87.3% vs. 89.5%, p = 0.6) and significant 1-year improvement in KCCQ scores (+16.5 vs. +22.3, p = 0.09) and NYHA functional class. However, more patients in the No-HFH group had 1-year NYHA class ≤II (HFH vs. No-HFH: 67.9% vs. 81.9%, p < 0.01). All-cause mortality at 1 year was 36.8% in the HFH group versus 10.4% in the No-HFH group (p < 0.001). The HFH rate decreased by 63% at 1 year post-M-TEER versus 1 year pre-treatment (relative risk 0.4, p < 0.001). Independent HFH associations were MR ≥2+ at discharge, HFH 1 year prior to treatment, baseline NYHA class ≥III, baseline tricuspid regurgitation ≥2+, and baseline left ventricular ejection fraction ≤40%.
Conclusions: This study reports the impact of HFH on clinical outcomes post-treatment in the EXPAND study. Results demonstrate that the occurrence of HFH was associated with worse 1-year survival, and treatment with the MitraClip system substantially reduced HFH and improved patient symptoms and quality of life.
(© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Databáze: MEDLINE
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