Impact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair.

Autor:	Sammour YM; Houston Methodist DeBakey Heart and Vascular Center, TX., Bou Chaaya RG; Houston Methodist DeBakey Heart and Vascular Center, TX., Hatab T; Houston Methodist DeBakey Heart and Vascular Center, TX., Zaid S; Houston Methodist DeBakey Heart and Vascular Center, TX., Aoun J; Houston Methodist DeBakey Heart and Vascular Center, TX., Makram OM; Houston Methodist DeBakey Heart and Vascular Center, TX., Wessly P; Houston Methodist DeBakey Heart and Vascular Center, TX., Samimi S; Houston Methodist DeBakey Heart and Vascular Center, TX., Nagueh SF; Houston Methodist DeBakey Heart and Vascular Center, TX., Zoghbi WA; Houston Methodist DeBakey Heart and Vascular Center, TX., Atkins MD; Houston Methodist DeBakey Heart and Vascular Center, TX., Reardon MJ; Houston Methodist DeBakey Heart and Vascular Center, TX., Faza N; Houston Methodist DeBakey Heart and Vascular Center, TX., Little SH; Houston Methodist DeBakey Heart and Vascular Center, TX., Kleiman NS; Houston Methodist DeBakey Heart and Vascular Center, TX., Goel SS; Houston Methodist DeBakey Heart and Vascular Center, TX.
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2024 Sep; Vol. 17 (9), pp. e014055. Date of Electronic Publication: 2024 Jun 05.
DOI:	10.1161/CIRCINTERVENTIONS.124.014055
Abstrakt:	Background: Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment. Methods: We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring. Patients were stratified into 3 groups according to tertiles of post-TEER mean LAP. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models. Results: We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]). Conclusions: Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. Exploration of reasons for elevated LAP after M-TEER and ways to lower it warrant further investigation. Competing Interests: Dr Atkins is a consultant for W. L. Gore & Associates; Dr Reardon is a consultant for Medtronic, Boston Scientific, Abbott, and W. L. Gore & Associates; Dr Kleiman is a local principal investigator in trials sponsored by Boston Scientific, Medtronic, Abbott, and Edwards Lifesciences; Dr Goel is a consultant for Medtronic, W. L. Gore & Associates, and JC Medical and is on the Speakers Bureau for Abbott Structural Heart. The other authors report no conflicts.
Databáze:	MEDLINE
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