Comparing the Prognostic Impact of Prediabetes with Diabetes in a Nationwide Cohort of Patients with Chronic Coronary Syndromes: An Analysis of the START Registry

Cardiology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Leonardo De Luca ◽  
Domenico Gabrielli ◽  
Lucio Gonzini ◽  
Carmine Riccio ◽  
Giuseppe Arena ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Event Rate ◽  
Adverse Event Rate ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Coronary Syndromes ◽  
Using Data ◽  
Cox Analysis ◽  
The Impact

<b><i>Aims:</i></b> Using data from the nationwide prospective START registry that enrolled a large cohort of patients with chronic coronary syndromes (CCS), we aimed to investigate whether the presence of diabetes mellitus (DM) and pre-DM independently affected the risk of cardiovascular events at 1-year follow-up. <b><i>Methods:</i></b> We assessed the impact of DM and pre-DM on all-cause mortality and a composite of all-cause mortality and hospitalization for cardiovascular causes at 1-year follow-up. <b><i>Results:</i></b> Among the 3,778 patients with available fasting plasma glucose data at study entry, 37% were classified as DM, 25% as pre-DM, and 38% as no DM. At 1 year, patients with DM had higher rates of all-cause death (<i>p</i> = 0.004) and death/cardiovascular hospitalization (<i>p</i> = 0.003) than those with pre-DM or without DM. Conversely, no significant differences in the adverse event rate were found between patients with pre-DM and those without DM. At unadjusted Cox analysis, DM resulted as a predictor of both death for any cause (hazard ratio [HR]: 2.41; 95% confidence intervals [CI]: 1.34–4.34; <i>p</i> = 0.003) and all-cause death/hospitalization for cardiovascular causes (HR: 1.29; 95% CI: 1.02–1.62; <i>p</i> = 0.03). However, DM did not result as an independent predictor of either endpoint at multivariate analysis. <b><i>Conclusions:</i></b> The risk of 1-year major events among patients with CCS and pre-DM is comparable to that of patients with CCS and normoglycemic status and is lower than that of patients with DM.

Prognostic impact of SYNTAX II score in patients with cardiogenic shock complicating ST-elevation myocardial infarction: analysis of an 10-year all-comers registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Juskova ◽  
P Tasende Rey ◽  
B Cid Alvarez ◽  
B Alvarez Alvarez ◽  
J.M Garcia Acuna ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Cardiac Events ◽  
Prognostic Information ◽  
St Segment Elevation ◽  
All Cause Mortality

Abstract Background The SYNTAX II score (SS-II) can predict 4-year outcomes in patients with complex coronary artery disease and ST-segment elevation myocardial infarction (STEMI). Nonetheless, the prognostic value of SS-II for a cardiogenic shock (CS) in the setting of STEMI has not been assessed. Purpose This study aimed to investigate the predictive impact of SS-II in patients with CS complicating STEMI undergoing primary percutaneous coronary intervention, and whether SS-II adds prognostic information to predict major adverse cardiac events (MACE) and all-cause death in this population. Methods This prospective cohort study included 1965 consecutive patients with STEMI who underwent primary-PCI between January 2008 and December 2017. The cohort of patients with CS (n=153) was identified and divided into three groups based on SS-II tertiles [SS-II low tertile &lt;38 (n=51), ≥38 SS-II intermediate tertile &lt;47 (n=51), and SS-II high tertile ≥48 (n=51)]. Results Amongst the cohort of patients with CS mean age was 68.4±14.0 years, 69.2% were male and 51.6% presented with anterior STEMI (mean SSII was 45.1±14). In-hospital mortality was significantly higher in the high SS-II tertile (85.7% vs. 38.9% vs 24.4%, p≤0.001) compared with SS-II intermediate and low tertiles. During follow-up (median 2.5 years), SS-II was positively correlated with MACE (89.3% (high SS-II) vs. 52.8% (int SS-II) vs. 42.2% (low SS-II), p≤0.001), and with all-cause mortality (89.3% vs 44.4% vs 26.7%, p≤0.001). The SS-II was also an independent predictor of MACE (HR=1.042, 95% CI: 1.020–1.063, p=0.000) and all-cause mortality during follow-up (HR=1.056, 95% CI: 1.033–1.079, p=0.000) Conclusion In a real-world cohort of patients with STEMI related CS, the SS-II added important prognostic information, being an independent predictor of MACE and all-cause mortality during follow-up. Image 1 Funding Acknowledgement Type of funding source: None

Long-term prognostic benefit of beta-blockers use after discharge in patients with Tako-Tsubo syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Jamhour-Chelh ◽  
S Raposeiras-Roubin ◽  
I Nunez-Gil ◽  
E Abu-Assi ◽  
D Aritza Conty ◽  
...  
Keyword(s):  
Large Scale ◽  
Beta Blockers ◽  
Funding Source ◽  
Prognostic Impact ◽  
Private Company ◽  
Cox Analysis ◽  
The Impact ◽  
Long Term Mortality

Abstract Background Tako-tsubo Syndrome (TS) seems to be associated with a catecholamine-mediated mechanism. However, the impact of beta-blockers (BB) in-hospital and after discharge still remain uncertain. Objectives: The purpose of the study was to examine whether BB use after discharge in patients with TS, was associated with lower long-term mortality and recurrence. Methods Using a national multicentre large-scale inpatient database (RETAKO Registry), we analysed patients with a definitive TS diagnosis. Results A total of 970 patients were analysed (568 with BB therapy and 402 no-BB therapy). After discharge and over a median of follow-up of 1.1 years, treatment with BB have no shown prognostic effectiveness in terms of mortality and TS recurrence in unadjusted and adjusted Cox analysis (HR 0.86; 95% CI: 0.59 to 1.27; and 0.95; 95% CI: 0.57–1.13, respectively). Conclusions This data suggests that use of beta-blockers after hospital discharge has not shown long-term prognostic benefit in patients with Tako-tsubo Syndrome. Prognostic impact of BB in TS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Retako webpage was funded by a non-conditioned Astrazeneca scholarship.

A Study on the Prognosis of Patients Relapsing after Autologous Stem Cell Transplantation (auto-SCT) for Follicular Lymphoma (FL): The Impact of Remission Duration.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3064-3064
Author(s):  
Julia Stumm ◽  
Jens Dreyhaupt ◽  
Martin Kornacker ◽  
Manfred Hensel ◽  
Michael Kneba ◽  
...  
Keyword(s):  
Cox Regression ◽  
Treatment Time ◽  
Salvage Treatment ◽  
Prognostic Impact ◽  
Post Transplant ◽  
Kaplan Meier ◽  
Cox Analysis ◽  
Time To Relapse ◽  
The Impact

Abstract Although auto-SCT has been in use for treatment of advanced FL since many years, little is known about the course of those who relapse after this procedure. Because these patients may be candidates for aggressive salvage approaches, we sought to study the outcome of patients with FL relapsing after auto-SCT with particular focus on factors predicting for survival. Methods: Relapse cases were identified retrospectively from 244 patients autografted for FL between August 1990 and November 2002 in 3 institutions. Overall survival after relapse (OS) was calculated according to Kaplan-Meier and analyzed for the prognostic impact of pre-relapse variables as well as of post-relapse salvage treatment by univariate log rank comparisons and Cox regression analyses. Results: With a median follow-up of 88 (5–186) months post auto-SCT, 104 relapses occurred, corresponding to a 10-year relapse probability of 0.47 (95%CI 0.4–0.53). Median age of relapsed patients was 48 (22–65) years. FLIPI score at diagnosis was low in 18%, intermediate in 58%, and high in 24%. In 51%, auto-SCT had been given as part of first-line treatment, and 45% had been in complete remission at auto-SCT. Myeloablation included total body irradiation (TBI) in 57% of the cases. Median time from auto-SCT to relapse was 19 (2–128) months, with only 2 relapses occurring later than 6 years post transplant. Transformed FL was present in 14% of those 87 patients who had relapse histology available. Rituximab-containing salvage therapy was given to 50% of the patients after relapse. With 45 (1–139) months of follow-up, median OS after relapse was 100 months. Log rank comparisons identified auto-SCT as part of salvage treatment, time to relapse <12 months, and salvage without rituximab as factors adversely influencing OS, while all other variables listed above had no impact. Cox analysis considering sex, age, salvage auto-SCT, TBI, time to relapse, and rituximab salvage confirmed a possible adverse impact of time to relapse <12 months (hazard ratio 2.58 (95%CI 0.99–6.82); p 0.055) but none of the other covariates on OS. Conclusions: The prognosis of patients relapsing after auto-SCT for FL is surprisingly good. However, those whose disease recurs within the first post-transplant year tend to have a dismal outcome and might benefit from experimental salvage approaches, such as allogeneic SCT.

scholarly journals P0807THE IMPACT OF GLOMERULAR FILTRATION RATE IN HEART FAILURE PATIENTS WITH CARDIAC IMPLANTABLE DEVICES - MYTH OR FACT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natacha Rodrigues ◽  
Afonso N Ferreira ◽  
Pedro António ◽  
Mafalda Carrington ◽  
João De Sousa ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Clinical Characteristics ◽  
Filtration Rate ◽  
Independent Predictor ◽  
Implantable Devices ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
The Impact

Abstract Background and Aims Heart Failure (HF) and chronic kidney disease (CKD) are both epidemic, frequently simultaneous and sharing well knowned risk factors. Implantable devices can improve quality of life and reduce mortality in a selected population. Data derived from meta-analyses show both survival benefit in CKD patients receiving devices and increased risk of death in device patients with CKD. Little is Known about the impact of glomerular filtration rate (GFR) across the different stages of CKD in the vital prognoses of HF patients submitted to cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implants. To evaluate the impact of CKD in all-cause mortality in HF patients who implanted a CRT or ICD. Method Prospective single-center study of patients who implanted CRT or ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry. CKD was evaluated according to the GFR by CKD-EPI equation according to the KDIGO guidelines. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor GFR levels, and according to the KDIGO classification, we assessed the best cut-off value for mortality using the area under the ROC curve (AUC) method. Results From 2015-2019, 974 devices were implanted, 414 ICDs and 560 CRTs (23.3% female, 67.6±12.1, follow-up duration 26.4±16.5 months). A total of 161 patients (16.5%) died during follow-up. GFR at the time of device implant was significantly lower in patients who died compared to those who survived (49.7 vs 67.3ml/min/1.73m2, p&lt;0.001). When evaluating predictors for all-cause mortality by multivariate analysis, GFR at the time of device implant was an independent predictor of mortality, even when adjusted for age, gender, arterial hypertension and diabetes (HR 1.12; 95% CI 1.04-1.16, p&lt;0.001). The best GFR cut-off value to predict mortality with a 69% sensitivity and 65% specificity was 75ml/min/1.73m2 (AUC 0.70). Patients with a GFR &lt; 75ml/min/1.73m2 at the time of implant have a 2.5-fold higher risk of death (HR 2.5; 95% CI 1.6-3.9, p&lt;0.001). Risk of death significantly increases along GFR decline, almost doubling each stage, with 2.7 for stage 3a (p=0.2), 5.5 for stage 3b, 9.5 for stage 4 and 14.7-fold higher risk of death for stage 5 (p&lt;0.001). Conclusion In our cohort of HF patients who underwent CRT or ICD implant, glomerular filtration rate was an independent predictor for all-cause mortality. Additionally, GFR&lt;75ml/min/1.73m2 at the time of device implant increased by 2.5-fold the risk of death, the risk doubles for each CKD stage increase, reaching a dramatic 14.7- fold higher risk of death for stage 5 patients. CKD should not postpone device implant, as its deterioration significantly increases the risk of death.

P1497Digoxin in patients with advanced heart failure and sinus rhythm - Is there any benefit?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Lopes ◽  
C Fernandes ◽  
M Madeira ◽  
N Antonio ◽  
L Elvas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sinus Rhythm ◽  
Acute Heart Failure ◽  
Cox Regression ◽  
Independent Predictor ◽  
Negative Influence ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Digoxin is one of the oldest drugs used in heart failure treatment. It is recommended in patients in sinus rhythm with still symptomatic heart failure with reduced ejection fraction. However, a controversy regarding digoxin use has risen with recent studies demonstrating an increased mortality and arrhythmias rate in patients taking this drug. Purpose The purpose of this study is to assess the prognostic impact of digoxin in patients in sinus rhythm with a CRT device, concerning all-cause mortality, hospitalizations due to acute heart failure and rate of ventricular arrhythmias. Methods A cohort of 297 consecutive P with advanced HF, sinus rhythm and a CRT device (80% with defibrillator) implanted between February 2004 and January 2016, in a single centre, was included in this retrospective study. Patients were divided in two groups regarding digoxin prescription (digoxin (DG) and without digoxin (NDG)).  A mean clinical follow-up of 5.3 ± 3.4 years regarding long term outcomes was performed. Cox regression was used to identify independent predictors of outcomes. Results Digoxin was prescribed in 104 P (35%). In this cohort 67% of P were males and the mean age was 64 ± 11 years. Patients in DG were younger (60 ± 11 vs 66 ± 10, p &lt; 0.001).  The 2 groups had similar prevalence of comorbidities, with exception of chronic kidney disease (GD 27.5% vs GND 33.3%, p = 0.05). The etiology was similar between the 2 groups (42% ischaemic). In the qui-square analysis, there was a statically significant association between the use of digoxin and mortality (DG 42.3% vs NDG 25.4%, p= 0.003), and also between digoxin and hospitalization with acute heart failure (DG 36.5% vs NDG 21.4%, p = 0.005). There was no association between digoxin use and the occurrence of ventricular tachycardia (DG 31.7% vs 40.1%, p = 0.155). In the Cox proportional hazards regression, accounting for the potential confounders, the use of digoxin was an independent predictor for all-cause mortality (HR = 2.80, CI 95 [1.07 – 7.31], p = 0.036) and also for hospitalization with acute heart failure (HR = 5.82, CI 95 [1.54 – 22.06], p = 0.010). Conclusion The use of digoxin was an independent predictor of all-cause mortality and hospitalizations due to acute heart failure. Randomized trials are needed to clarify the impact of digoxin and determine if it is only an indicator of disease severity and worse prognosis or if the drug has a direct negative influence in the natural history of P with heart failure. Abstract Figure.

scholarly journals Are our patients waiting too long for cardiac surgery?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Menezes Fernandes ◽  
T.F Mota ◽  
J.S Bispo ◽  
H Costa ◽  
D Bento ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Waiting Time ◽  
Independent Predictor ◽  
Valvular Disease ◽  
Prognostic Impact ◽  
Mean Waiting Time ◽  
The Mean ◽  
The Impact

Abstract Introduction Recommended pre-established waiting periods in patients referred for cardiac surgery aim to improve clinical outcomes. Purpose To determine the prognostic impact of the delay until cardiac surgery. Methods We conducted a retrospective study encompassing patients referred to cardiac surgery from a Cardiology Department, since January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Primary endpoints were global mortality and re-hospitalization rates at follow-up. Independent predictors of clinical outcomes were identified through a binary logistic regression analysis, considering p=0,05. Results A total of 591 patients were included, with 71,1% male predominance and a mean age of 68,6±11,36 years old. 55,2% of patients had severe valvular disease (aortic – 38,6%, mitral – 9,6%, mixed valvular disease – 2,9%), and 37,1% had surgical coronary artery disease. The mean left ventricle ejection fraction was 56,1% ± 12,2% and the mean Euroscore II was 3,7%. 120 patients (20,3%) required more than one type of surgical intervention. 360 patients (60,9%) were referred to elective procedures, with a mean waiting time of 129,4 days and only 29,2% of them were operated in a 6-week period. The remaining 39,1% of patients needed urgent/emergent surgery, and the mean time until the intervention was 27,2 days (70,1% operated in 2-weeks). Mean waiting time was higher for valvular patients comparing with coronary patients (110,7 vs 48 days; p&lt;0,001). 9,8% and 4,6% of patients were re-hospitalized or died while waiting for surgery, respectively. In a median follow-up of 520 days since the surgical referral, 25,5% of patients were re-hospitalized and 13,7% died. Waiting time was an independent predictor of global mortality (p=0,018), as well as arterial hypertension (p=0,002), severe valvular disease (p&lt;0,001) and higher Euroscore II values (p=0,023). Waiting for surgery in an out-patient setting (p=0,011) and higher Euroscore II values (p=0,002) were independent predictors of re-hospitalization. Conclusion In our study, waiting time until surgery was an independent predictor of global mortality. Efforts should be made to enable referral surgical centres to timely respond to the needs of the population, considering the impact that delaying the appropriate treatment can have on the survival of these patients. Funding Acknowledgement Type of funding source: None

Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

2020 ◽  
Author(s):  
Erico Castro-Costa ◽  
Jerson Laks ◽  
Cecilia Godoi Campos ◽  
Josélia OA Firmo ◽  
Maria Fernanda Lima-Costa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Old Age ◽  
All Cause Mortality ◽  
The Impact

scholarly journals POS0941 IN SPONDYLOARTHRITIS PATIENTS THE PRESENCE OF COMORBIDITIES IS AN INDEPENDENT PREDICTOR OF INSUFFICIENT RESPONSE TO THERAPY WITH BIOLOGIC AGENTS AND TREATMENT DISCONTINUATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 733.2-734
Author(s):  
I. Flouri ◽  
N. Kougkas ◽  
N. Avgustidis ◽  
A. Repa ◽  
A. Eskitzis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Disease Duration ◽  
Cox Regression ◽  
Independent Predictor ◽  
Response To Therapy ◽  
Treatment Discontinuation ◽  
Randomized Controlled Studies ◽  
Insufficient Response ◽  
The Impact

Background:Long-term observational studies of patients under biologic disease-modifying anti-rheumatic drug (bDMARD) therapies in routine clinical practice can provide us with important data regarding patients with comorbidities, who are usually excluded from randomized controlled studies.Objectives:To study the impact of comorbidities in the outcome (response and persistence to therapy) of patients with spondyloarthritis (SpA) receiving bDMARDs in real-world clinical practice.Methods:Prospective study of all patients who start a bDMARD in a tertiary centre University Hospital after their consent. All patient comorbidities [among a list of approximately 100 pre-specified major comorbidities] are registered by treating physicians at baseline and during follow-up.Comorbidities were studied as total Comorbidities Count (CC) and rheumatic disease comorbidity index (RDCI). Statistical analyses were performed using logistic and Cox regression models, adjusting for the potential confounding of age, sex, disease duration, diagnosis (axial vs. peripheral SpA), number of previous conventional synthetic and biologic DMARDs, year of therapy start, and co-administered methotrexate and corticosteroids (yes/no). Analyses of response to therapy also included baseline BASDAI or ASDAS indices as confounding variables.Results:A total of 603 biologic treatments (1st: 298, 2nd: 157, ≥3rd: 148) were analyzed. Half (51%) of the patients were female, 413 patients had axial SpA (AxSpA) and 190 peripheral SpA (perSpA). At baseline, median (IQR) age: 48 (38-57) years, disease duration: 11 (4-19) years, CC: 2 (1-4) and RDCI: 1 (0-2). Both comorbidity indices were significantly higher in perSpA compared to AxSpA (p<0.001).At 6 months of therapy, 31% of patients with AxSpA achieved BASDAI50 and 39% had ASDAS-ESR < 2.1. Higher CC was an independent predictor of insufficient response according to BASDAI50 [OR (95%) = 0.70 (0.52-0.94), p=0.019] and higher RDCI was predicting failure to achieve ASDAS-ESR < 2.1 [OR (95%) = 0.59 (0.37-0.94), p=0.027]. Other independent predictors of non-response were age, longer disease duration and (for ASDAS-ESR<2.1) higher baseline disease activity.During 1405 patient-years of follow-up, 349 (58%) treatments were discontinued. The adjusted hazard ratio for bDMARD discontinuation within the first 2 years of treatment due to insufficient response was doubled in patients with CC ≥2 versus those with CC ≤1 [HR = 2.27 (1.14-4.53), p=0.020] or with RDCI ≥1 (vs. RDCI = 0) [HR = 2.23 (1.22-4.07), p=0.009]. Comorbidities’ indices were not significant predictors of treatment discontinuations due to adverse events.Conclusion:The presence of comorbidities in patients with SpA is an independent predictor for insufficient 6-month response to bDMARDs and resultant treatment discontinuation due to failure.Acknowledgements:This research is co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning» in the context of the project “Reinforcement of Postdoctoral Researchers - 2nd Cycle” (MIS-5033021), implemented by the State Scholarships Foundation (ΙΚΥ).Disclosure of Interests:None declared

scholarly journals Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Haiyun Yu ◽  
Juanhui Pei ◽  
Xiaoyan Liu ◽  
Jingzhou Chen ◽  
Xian Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Sudden Cardiac Death ◽  
Chronic Heart Failure ◽  
Cardiac Death ◽  
Independent Predictor ◽  
All Cause Mortality ◽  
Patient Prognosis ◽  
The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

scholarly journals Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair

2021 ◽  
Author(s):  
Martin Geyer ◽  
Karsten Keller ◽  
Kevin Bachmann ◽  
Sonja Born ◽  
Alexander R. Tamm ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Survival Data ◽  
Common Finding ◽  
Prognostic Impact ◽  
Term Survival ◽  
Long Term Prognosis ◽  
The Impact ◽  
Symptomatic Benefit

Abstract Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract

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