| Autor: |
Sammour, Yasser M., Bou Chaaya, Rody G., Hatab, Taha, Zaid, Syed, Aoun, Joe, Makram, Omar M., Wessly, Priscilla, Samimi, Sahar, Nagueh, Sherif F., Zoghbi, William A., Atkins, Marvin D., Reardon, Michael J., Faza, Nadeen, Little, Stephen H., Kleiman, Neal S., Goel, Sachin S. |
| Zdroj: |
Circulation: Cardiovascular Interventions; Sep2024, Vol. 17 Issue 9, p827-837, 11p |
| 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 allcause 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. GRAPHIC ABSTRACT: A graphic abstract is available for this article. [ABSTRACT FROM AUTHOR] |
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