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Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry.
Eur J Heart Fail. 2018 03; 20(3):585-594.EJ

Abstract

AIMS

We sought to evaluate the impact of pulmonary hypertension on outcomes following MitraClip therapy.

METHODS AND RESULTS

The 643 patients in the TRAnscatheter Mitral valve Interventions (TRAMI) registry were divided into three groups according to echocardiographically graded systolic pulmonary artery pressure (sPAP) (Group 1: patients with sPAP of ≤36 mmHg; Group 2: patients with sPAP of 37-50 mmHg; Group 3: patients with sPAP of >50 mmHg) and followed for 1 year. Recent cardiac decompensation, aortic valve disease and tricuspid valve insufficiency were observed more frequently in patients with higher sPAP. Furthermore, logEuroSCORE, Society of Thoracic Surgeons score and age were higher with rising sPAP values. No differences were observed in mitral regurgitation (MR) severity, co-morbidities or clinical findings (New York Heart Association class, 6-min walking distance). Reduction to MR of grade 1 or lower was achieved more often in patients with lower sPAP levels (P = 0.01). In Groups 2 and 3, sPAP was reduced significantly. Major adverse cardiac or cardiovascular events (MACCEs) occurring in hospital (death, myocardial infarction, stroke; <4% in each group), as well as 30-day rates of MACCEs (6.1% in Group 1, 11.9% in Group 2, 12.4% in Group 3) and rehospitalization (18.9% in Group 1, 24.8% in Group 2, 24.8% in Group 3) did not differ significantly. At 1 year, differences in rates of mortality and MACCEs (20.3% in Group 1, 33.1% in Group 2, 34.7% in Group 3; P < 0.01) were significant. Both Groups 2 [hazard ratio (HR) 1.81, P = 0.0122] and 3 (HR 1.85, P = 0.0092) were independently predictive of death. Rehospitalization rates did not differ during follow-up.

CONCLUSIONS

Despite higher mortality in patients with elevated sPAP, these data suggest the safety, feasibility and benefit of MitraClip therapy even in advanced stages of disease. An early approach might prevent the progress of pulmonary hypertension and improve outcomes.

Authors+Show Affiliations

Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.Department of Cardiology, University Medical Centre Mainz, Mainz, Germany.Department of Cardiology, University Medical Centre Tübingen, Tübingen, Germany.Department of Cardiology, Angiology and Pneumology, University Medical Centre Heidelberg, Heidelberg, Germany.Institute for Myocardial Infarction Research, Ludwigshafen, Germany.Cardiovascular Centre, St Katharinen Hospital, Frankfurt am Main, Germany.Department of Internal Medicine, Medical Clinic II, University Medical Centre Bonn, Bonn, Germany.Department of Cardiology and Angiology, Helios Clinic Siegburg, Siegburg, Germany.Institute for Myocardial Infarction Research, Ludwigshafen, Germany.Department of Internal Medicine I, Helios Albert-Schweitzer-Hospital, Northeim, Germany.Department of General and Interventional Cardiology, University Heart Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29575435

Citation

Tigges, Eike, et al. "Implication of Pulmonary Hypertension in Patients Undergoing MitraClip Therapy: Results From the German Transcatheter Mitral Valve Interventions (TRAMI) Registry." European Journal of Heart Failure, vol. 20, no. 3, 2018, pp. 585-594.
Tigges E, Blankenberg S, von Bardeleben RS, et al. Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail. 2018;20(3):585-594.
Tigges, E., Blankenberg, S., von Bardeleben, R. S., Zürn, C., Bekeredjian, R., Ouarrak, T., Sievert, H., Nickenig, G., Boekstegers, P., Senges, J., Schillinger, W., & Lubos, E. (2018). Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry. European Journal of Heart Failure, 20(3), 585-594. https://doi.org/10.1002/ejhf.864
Tigges E, et al. Implication of Pulmonary Hypertension in Patients Undergoing MitraClip Therapy: Results From the German Transcatheter Mitral Valve Interventions (TRAMI) Registry. Eur J Heart Fail. 2018;20(3):585-594. PubMed PMID: 29575435.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implication of pulmonary hypertension in patients undergoing MitraClip therapy: results from the German transcatheter mitral valve interventions (TRAMI) registry. AU - Tigges,Eike, AU - Blankenberg,Stefan, AU - von Bardeleben,R Stephan, AU - Zürn,Christine, AU - Bekeredjian,Raffi, AU - Ouarrak,Taoufik, AU - Sievert,Horst, AU - Nickenig,Georg, AU - Boekstegers,Peter, AU - Senges,Jochen, AU - Schillinger,Wolfgang, AU - Lubos,Edith, Y1 - 2017/07/24/ PY - 2016/11/22/received PY - 2017/03/09/revised PY - 2017/03/18/accepted PY - 2018/3/26/entrez PY - 2018/3/27/pubmed PY - 2018/12/15/medline KW - Heart failure KW - MitraClip KW - Mitral regurgitation KW - Pulmonary hypertension KW - TRAMI registry KW - Transcatheter mitral valve repair SP - 585 EP - 594 JF - European journal of heart failure JO - Eur. J. Heart Fail. VL - 20 IS - 3 N2 - AIMS: We sought to evaluate the impact of pulmonary hypertension on outcomes following MitraClip therapy. METHODS AND RESULTS: The 643 patients in the TRAnscatheter Mitral valve Interventions (TRAMI) registry were divided into three groups according to echocardiographically graded systolic pulmonary artery pressure (sPAP) (Group 1: patients with sPAP of ≤36 mmHg; Group 2: patients with sPAP of 37-50 mmHg; Group 3: patients with sPAP of >50 mmHg) and followed for 1 year. Recent cardiac decompensation, aortic valve disease and tricuspid valve insufficiency were observed more frequently in patients with higher sPAP. Furthermore, logEuroSCORE, Society of Thoracic Surgeons score and age were higher with rising sPAP values. No differences were observed in mitral regurgitation (MR) severity, co-morbidities or clinical findings (New York Heart Association class, 6-min walking distance). Reduction to MR of grade 1 or lower was achieved more often in patients with lower sPAP levels (P = 0.01). In Groups 2 and 3, sPAP was reduced significantly. Major adverse cardiac or cardiovascular events (MACCEs) occurring in hospital (death, myocardial infarction, stroke; <4% in each group), as well as 30-day rates of MACCEs (6.1% in Group 1, 11.9% in Group 2, 12.4% in Group 3) and rehospitalization (18.9% in Group 1, 24.8% in Group 2, 24.8% in Group 3) did not differ significantly. At 1 year, differences in rates of mortality and MACCEs (20.3% in Group 1, 33.1% in Group 2, 34.7% in Group 3; P < 0.01) were significant. Both Groups 2 [hazard ratio (HR) 1.81, P = 0.0122] and 3 (HR 1.85, P = 0.0092) were independently predictive of death. Rehospitalization rates did not differ during follow-up. CONCLUSIONS: Despite higher mortality in patients with elevated sPAP, these data suggest the safety, feasibility and benefit of MitraClip therapy even in advanced stages of disease. An early approach might prevent the progress of pulmonary hypertension and improve outcomes. SN - 1879-0844 UR - https://www.unboundmedicine.com/medline/citation/29575435/Implication_of_pulmonary_hypertension_in_patients_undergoing_MitraClip_therapy:_results_from_the_German_transcatheter_mitral_valve_interventions__TRAMI__registry_ L2 - https://doi.org/10.1002/ejhf.864 DB - PRIME DP - Unbound Medicine ER -