DIASTOLOGY AND MITRACLIP OUTCOMES: MULTICENTER REAL WORLD EVIDENCE STUDY
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
INTRODUCTION
MitraClip ® (MC) placement has been extensively used as an intervention for mitral transcatheter edge-to-edge repair (mTEER) for functional mitral regurgitation (FMR). The aim of our study is to analyze the association between pre procedural echocardiographic parameters of diastolic function (DF) and one-year outcomes after MC placement.
STUDY DESIGN AND METHODS
The study was designed in retrospective longitudinal cross-sectional format. 224 patients who underwent MC placement between January of 2021 and March of 2024 at Prisma Health Richland, Baptist and Greenville were included in the study. Primary Efficacy Endpoint (PEE) was determined by absence of heart failure hospitalizations requiring Intravenous Diuretics or Cardiac related death in the one year follow up. One-way ANOVA was used to determine variance of echo parameters between groups. Multivariate regression analysis was done to identify pre-procedural echocardiographic parameters of DF that held significant association with failure to reach the PEE. A two tailed p-value < 0.05 was used to determine statistical significance.
RESULTS
Of the 224 patients included in the study, 85 patients (37.94%) failed to reach the PEE or had symptom worsening. The mean mitral valve (MV) deceleration time was 176.88 ms (164.14 - 189.62) in the symptom worsening group compared to 201.53 ms (186.01 - 217.07) in the symptom improvement group. Mean of E/A ratio (MV peak E velocity/ A velocity) was noted to be 2.35 (1.97 - 2.74) in the symptom worsening group compared to 1.90 (1.68 - 2.13) in the symptom improvement group. After multivariate regression analysis, E/A ratio was found to have significant association with failure to reach PEE: Odds Ratio (OR): 1.61 (1.13 - 2.29), p-value: 0.008. Area under the curve (AUC) analysis for the E/A ratio was calculated at 0.603 (0.50 - 0.69) for symptom worsening group.
CONCLUSIONS
Patients that failed to reach the PEE had a lower pre-procedural MV deceleration time of 176.88 ms (164.14 - 189.62), however no association was observed between MV deceleration time and failure to reach the PEE in the multivariate regression analysis. Pre-procedural E/A ratio had significant association with symptom worsening after multivariate regression analysis: OR: 1.61 (1.13 - 2.29). AUC for E/A ratio in symptom worsening group was 0.603, making it a moderate predictor than random guessing for failure to reach the PEE.
