Prognostic Impact of the Pulmonary Artery Pulsatility Index in Patients with Chronic Heart Failure and Severe Mitral Regurgitation Undergoing Percutaneous Edge-to-Edge Repair

Cardiology ◽  
2020 ◽  
Vol 146 (1) ◽  
pp. 74-84
Author(s):  
Rico Osteresch ◽  
Kathrin Diehl ◽  
Johannes Schmucker ◽  
Azza Ben Ammar ◽  
Oana Solyom ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Chronic Heart Failure ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Primary Endpoint ◽  
Pulsatility Index ◽  
Operative Risk ◽  
Prognostic Impact

<b><i>Background:</i></b> Pulmonary artery (PA) pulsatility index (PAPi), calculated as (PA systolic pressure – PA diastolic pressure)/right atrial pressure, emerged as a novel predictor of right ventricular failure in patients with acute inferior myocardial infarction, advanced heart failure, and severe pulmonary hypertension. However, the prognostic utility of PAPi in transcatheter mitral valve repair (TMVR) using the MitraClip® system has never been tested. <b><i>Objective:</i></b> To assess the prognostic impact of PAPi in patients with severe functional mitral regurgitation (MR) and chronic heart failure (CHF) undergoing TMVR. <b><i>Methods:</i></b> Consecutive patients with severe functional MR (grade 3+ or 4+) and CHF who underwent successful TMVR (MR ≤2+ at discharge) were enrolled and divided into 3 groups according to PAPi (A: low PAPi ≤2.2; B: intermediate PAPi 2.21–3.99; C: high PAPi ≥4.0). The primary endpoint was a composite of all-cause mortality and rehospitalization due to CHF during a mean follow-up period of 16 ± 4 months. The impact of PAPi on prognosis was assessed by a receiver-operating characteristic (ROC) analysis and a multivariable Cox proportional hazard regression analysis investigating independent predictors for outcome. <b><i>Results:</i></b> 78 patients (A: <i>n</i> = 27, B: <i>n</i> = 28, C: <i>n</i> = 23) at high operative risk (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation] 18.8 vs. 21.5 vs. 20.6%; nonsignificant) were enrolled. Mean PAPi was 1.6 ± 0.41 vs. 2.9 ± 0.53 vs. 6.8 ± 3.5; <i>p</i> &#x3c; 0.001). Patients with low PAPi showed significantly higher rates of early rehospitalization for heart failure at the 30-day follow-up (14.9 vs. 7.1 vs. 4.3%; <i>p</i> = 0.04). In the long term, a significantly lower event-free survival for the combined primary endpoint was observed in the low PAPi group (44.4 vs. 25.0 vs. 20.3%; log-rank <i>p</i> = 0.016). ROC curve analysis revealed that optimal sensitivity and specificity were achieved using a PAPi cutoff of 2.46 (sensitivity 83%, specificity 78.3%, area under the curve 0.82 [0.64–0.99]; <i>p</i> = 0.01). In Cox regression analysis, PAPi ≤2.46 was an independent predictor for the combined primary endpoint (hazard ratio 2.85; 95% confidence interval 1.15–7.04; <i>p</i> = 0.023). <b><i>Conclusions:</i></b> PAPi is strongly associated with clinical outcome among patients with CHF and functional MR undergoing TMVR. A PAPi value ≤2.46 predicts a worse prognosis independent of other important clinical, echocardiographic, and hemodynamic factors. Therefore, PAPi may serve as a new parameter to improve patient selection for TMVR.

scholarly journals Refining the prognostic impact of functional mitral regurgitation in chronic heart failure

2017 ◽  
Vol 39 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Georg Goliasch ◽  
Philipp E Bartko ◽  
Noemi Pavo ◽  
Stephanie Neuhold ◽  
Raphael Wurm ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Prognostic Impact

Prognostic value and usefulness of Pulmonary Artery Pulsatility index (PAPi) in evaluation of heart transplant candidates

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bellettini ◽  
S Pidello ◽  
G Gallone ◽  
S Frea ◽  
M Masetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Primary Endpoint ◽  
Pulmonary Circulation ◽  
Pulsatility Index ◽  
Prognostic Value ◽  
Cox Regression ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Rv Function

Abstract Background Heart transplantation (HTx) is considered the best available treatment for patients with end stage heart failure. Candidate evaluation with right heart catheterization (RHC) is fundamental in order to exclude pulmonary hypertension with irreversible high pulmonary vascular resistance (PVR), which is associated with elevated post-HTx mortality. PVR, rather than directly measured, is derived by cardiac output and pulmonary artery pressures, which are strictly dependent on right ventricular (RV) function. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating the information of RV function and of pulmonary circulation, which could be useful in pre-HTx evaluation. Purpose We designed this study to evaluate the potential predictive influence of pre-HTx PAPi on post-HTx survival and to assess whether this index could add useful information in the pre-HTx evaluation of patients with advanced heart failure. Methods Consecutive adult HTx recipient at two medium-large tranplant centers between 2000 and 2017 with available data on pre-HTx RHC were retrospectively included. PAPi was calculated as the ratio of pulmonary artery pulse pressure to right atrial pressure. PAPi values in the lowest quartile were defined as reduced (PAPi&lt;1.67). The primary endpoint was all-cause mortality at 1-year post-HTx. The association of reduced PAPi with the primary endpoint was evaluated. Cox regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by PVR status (≥3 WU vs. &lt;3 WU) were also performed. Results Among 655 HTx recipients (female 20,8%, age 53±11 years), median pre-HTx PAPi was 3.0 (interquartile range 1.67–5.32). Patients in the lowest versus the remaining PAPi quartiles had significantly reduced 1-year survival (78.0% vs 87.2%, p=0.006), also after adjusting for age, estimated glomerular filtration rate, total bilirubin, high PVR and urgent transplantation (adj-hazard ratio: 0.64; 95% confidence interval 0.51–0.82). When stratifying patients by estimated PVR status, reduced PAPi was associated with worse 1-year survival among patients with normal PVR (78.3% vs. 88.3% p=0.011), but not in those with increased PVR (78.0% vs. 82.6%, p=0.36) (Figure 1). Conclusions Pre-HTx PAPi, integrating information of RV function and pulmonary circulation, provides incremental prognostic value over traditional clinical and hemodynamic parameters among HTx recipient. The prognostic value appears important among patients with normal estimated PVR, possibly due to an underestimation of PVR in patients with impaired RV function. The integration of PAPi in the pre-HTx evaluation may lead to better patient selection and post-HTx survival. Figure 1. 1 year survival stratified by PVR status Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic impact and post-procedural development of severe tricuspid regurgitation in patients undergoing transcatheter edge-to-edge mitral valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kavsur ◽  
C Iliadis ◽  
C Metze ◽  
M Spieker ◽  
V Tiyerili ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Odds Ratio ◽  
Survival Rates ◽  
Right Atrial ◽  
Prognostic Impact ◽  
Severe Tricuspid Regurgitation ◽  
Significant Difference

Abstract Purpose The aim of this study was to investigate the clinical impact and post-procedural development of tricuspid regurgitation (TR) in patients undergoing the MitraClip procedure for severe mitral regurgitation. Methods In this present multicentre study, we included 940 patients undergoing MitraClip implantation for symptomatic mitral regurgitation from August 2010 to September 2018. Patients were categorized according to concomitant TR (none or mild vs moderate vs severe) and the prognostic impact of TR on 1-year mortality was evaluated. Moreover, in 377 patients, we assessed 3-months echocardiographic controls to further analyse the post-procedural development of TR. Results At baseline, concomitant TR was graded none/mild in 393 (42%), moderate in 316 (34%), and severe in 231 (25%) patients. During 1-year follow-up, 141 of 940 (15%) patients died. According to mild/none, moderate and severe TR, mortality rates were 13%, 12%, and 23%, respectively, revealing a higher prevalence of death in patients with severe TR (p=0.001). Kaplan-Meier analysis and log-rank test confirmed inferior survival rates for patients with severe TR (p=0.001), while there were no significant difference in survival rates between patients with none/mild vs moderate TR (p=0.561). Regarding 1-year mortality, multivariate cox regression analysis, revealed an odds ratio of 1.739 (1.024–2.953; p=0.041), associated with severe TR. After 3-months follow-up, echocardiography in 377 patients showed following TR grade distributions: 44% none/mild, 37% moderate and 19% severe TR. In 100 patients (27%), TR improved by one or more grades, while 64 patients (17%) showed a TR worsening. In patients with severe TR at baseline, 42 of 91 (46%) patients showed a reduction in TR of one or more grades. Patients with severe TR at baseline, who showed a TR improvement during 3-months follow-up, had lower rates of 1-year mortality (p=0.025). For these patients, in regression analysis, right atrial area was revealed as only predictor of TR improvement after MitraClip procedure [odds ratio 0.958 (0.918–0.999); p=0.046]. Conclusion One-fourth of patients undergoing MitraClip procedure for mitral regurgitation had concomitant severe tricuspid regurgitation which was predictive for worse prognosis. Post-procedural TR improvement of one or more grades was frequent in these patients and was associated with higher survival-rates. Funding Acknowledgement Type of funding source: None

Thyroid Disorders and Prognosis in Chronic Heart Failure: A Long-Term Follow-Up Study

2020 ◽  
Vol 20 (3) ◽  
pp. 437-445
Author(s):  
Massimo Iacoviello ◽  
Giuseppe Parisi ◽  
Margherita I. Gioia ◽  
Dario Grande ◽  
Caterina Rizzo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Chronic Heart Failure ◽  
Thyroid Disorders ◽  
Heart Failure Hospitalization ◽  
End Point ◽  
Long Term Follow Up ◽  
Worse Prognosis

Background: Thyroid disorders may have a negative impact on the prognosis of patients affected by chronic heart failure (CHF). Objective: The aim of the current study was to evaluate the prognostic role of all thyroid disorders over a long term follow-up in a single centre large sample of CHF outpatients. Methods: In all patients, the function of the thyroid was evaluated at the enrolment and during the follow- up. On the basis of free triiodothyronine (T3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) serum levels, patients were classified into one of the following four categories: euthyroid subjects, patients affected by hypothyroidism, low T3 (LT3) syndrome and hyperthyroidism. During the follow-up, death for all causes was assessed as primary end-point, whereas time to the first hospitalization for heart failure worsening was the secondary end-point analyzed. Results: Among 762 patients, 190 patients were affected by hypothyroidism (Hypo). LT3 syndrome was diagnosed in 15 patients and 59 patients were affected by hyperthyroidism (Hyper). During a long term follow-up (5.1±3.7 years), 303 patients died. Patients with Hypo showed an increased risk of death as well as of hospitalization due to heart failure worsening at univariate regression analysis. At multivariate regression analysis, Hypo remained associated with hospitalization after correction for age >75 years, ischemic aetiology, diabetes, therapy with ACE-inhibitors or ARBs, therapy with betablockers and with aldosterone antagonists, NYHA class 3, systolic arterial pressure <95 mmHg, left ventricular ejection fraction <30%, estimated glomerular filtration rate <60 ml/min, hyponatremia and NTproBNP> 1000 pg/ml. At multivariate analysis, the independent association with death was significant only for the subgroup of patients with TSH >10 mIU/L. LT3 was independently associated with both heart failure hospitalization and death, whereas Hyper was not associated with any of the two considered end-points. Conclusion: Hypo is associated with a worse prognosis over a long-term follow-up. The association with heart failure hospitalization is not dependent on the baseline TSH levels, whereas the association with death is significant only when TSH >10 mIU/L. Finally, Hyper does not have any association with a worse prognosis.

Prognostic impact of haemostatic derangements in chronic heart failure

2009 ◽  
Vol 102 (08) ◽  
pp. 314-320 ◽  
Author(s):  
Nina Vene ◽  
Barbara Salobir ◽  
Miran Šebeštjen ◽  
Mišo Šabovic ◽  
Irena Keber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Independent Predictor ◽  
Nyha Class ◽  
Prognostic Impact ◽  
Prognostic Predictor ◽  
Baseline Levels ◽  
Pai 1 ◽  
D Dimer

SummaryHeart failure is characterised by activation of haemostasis. We sought to explore the prognostic impact of deranged haemostasis in chronic heart failure. In stable, optimally managed outpatients with chronic heart failure, baseline levels of prothrombin fragment F1+2, D-dimer, and tPA and PAI-1 antigens were determined. Clinical follow-up was obtained and the rate of events (heart failure related deaths or hospitalisations) was recorded. We included 195 patients [32.3% female, NYHA class II (66.2%) or III (33.8%), mean age 71 years]. During a median follow up of 693 (interquartile range [IQR] 574–788) days, 63 (30.9%) patients experienced an event; those with an event had higher levels of tPA antigen (median 11.8 [IQR 8.7–14.0] vs. 9.4 [7.9–12.1] µg/l; p=0.033) and D-dimer (938 [485–1269] vs. 620 [37–1076] µg/l; p=0.018). However, on Cox multivariate analysis, only tPA levels above optimal cut-off value of 10.2 µg/l (but not D-dimer) emerged as an independent predictor of prognosis (HRadjusted 2.695, 95% confidence interval 1.233–5.363; p=0.017). Our findings suggest that elevated tPA antigen levels are an independent prognostic predictor in patients with chronic stable heart failure.

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