Predictors of outcome in patients undergoing MitraClip implantation

An aid to improve patient selection

Kirsten Boerlage-vanDijk, Esther M A Wiegerinck, Motoharu Araki, Paola G. Meregalli, Navin R. Bindraban, Karel T. Koch, M. Marije Vis, Jan J. Piek, Jan G P Tijssen, Berto J. Bouma, Jan Baan

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: MitraClip implantation (MCI) reduces mitral regurgitation (MR) and symptoms in patients considered inoperable or with high-surgical risk. Data to determine the benefit from MCI for an individual patient are limited. The aim of this study is to determine predictors associated with the prognosis after MCI to improve the patient selection for this procedure. Methods: We included 84 consecutive patients (age: 76 ± 10 years, 51% male) who underwent MCI in our institution for symptomatic severe MR. All patients underwent transthoracic echocardiography before MCI; clinical and echocardiographic follow-up was obtained after MCI. Results: The 2-year survival was 81%. Predictors for two-year mortality in multi-variate analysis were baseline NT-proBNP ≥ 5000 μg/L (HR: 5.4, 95% CI: 1.8-16.2), previous valve surgery (HR: 4.5, 95% CI: 1.7-12.2), tricuspid regurgitation (TR) ≥ grade 3 prior to MCI (HR: 2.8, 95% CI: 1.2-6.8) and absence of MR reduction after MCI (HR: 2.1, 95% CI: 1.2-3.8). The 2-year survival of patients with 0, 1 or ≥2 of these predictors was: 87%; 78% and 38% respectively (log-rank p <0.001). The functional class at 1 month and mid-term follow-up was worse in patients with two or more of these predictors present at baseline compared to patients with zero or one of these predictors (1 month: p = 0.007 and mid-term: p <0.001). Conclusion: Heart failure, previous valve surgery, co-presence of TR and the degree of MR reduction after MCI are the independent predictors of survival and functional status after MCI in high risk patients. The pre-procedural characteristics may be used to optimize patient selection, while maximal MR reduction should be attempted to optimize the outcome of MCI.

Original languageEnglish
Pages (from-to)238-243
Number of pages6
JournalInternational Journal of Cardiology
Volume189
Issue number1
DOIs
Publication statusPublished - Jun 15 2015

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Patient Selection
Mitral Valve Insufficiency
Tricuspid Valve Insufficiency
Survival
Echocardiography
Heart Failure
Mortality

Keywords

  • MitraClip
  • Mitral regurgitation
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of outcome in patients undergoing MitraClip implantation : An aid to improve patient selection. / Boerlage-vanDijk, Kirsten; Wiegerinck, Esther M A; Araki, Motoharu; Meregalli, Paola G.; Bindraban, Navin R.; Koch, Karel T.; Vis, M. Marije; Piek, Jan J.; Tijssen, Jan G P; Bouma, Berto J.; Baan, Jan.

In: International Journal of Cardiology, Vol. 189, No. 1, 15.06.2015, p. 238-243.

Research output: Contribution to journalArticle

Boerlage-vanDijk, K, Wiegerinck, EMA, Araki, M, Meregalli, PG, Bindraban, NR, Koch, KT, Vis, MM, Piek, JJ, Tijssen, JGP, Bouma, BJ & Baan, J 2015, 'Predictors of outcome in patients undergoing MitraClip implantation: An aid to improve patient selection', International Journal of Cardiology, vol. 189, no. 1, pp. 238-243. https://doi.org/10.1016/j.ijcard.2015.01.045
Boerlage-vanDijk, Kirsten ; Wiegerinck, Esther M A ; Araki, Motoharu ; Meregalli, Paola G. ; Bindraban, Navin R. ; Koch, Karel T. ; Vis, M. Marije ; Piek, Jan J. ; Tijssen, Jan G P ; Bouma, Berto J. ; Baan, Jan. / Predictors of outcome in patients undergoing MitraClip implantation : An aid to improve patient selection. In: International Journal of Cardiology. 2015 ; Vol. 189, No. 1. pp. 238-243.
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abstract = "Background: MitraClip implantation (MCI) reduces mitral regurgitation (MR) and symptoms in patients considered inoperable or with high-surgical risk. Data to determine the benefit from MCI for an individual patient are limited. The aim of this study is to determine predictors associated with the prognosis after MCI to improve the patient selection for this procedure. Methods: We included 84 consecutive patients (age: 76 ± 10 years, 51{\%} male) who underwent MCI in our institution for symptomatic severe MR. All patients underwent transthoracic echocardiography before MCI; clinical and echocardiographic follow-up was obtained after MCI. Results: The 2-year survival was 81{\%}. Predictors for two-year mortality in multi-variate analysis were baseline NT-proBNP ≥ 5000 μg/L (HR: 5.4, 95{\%} CI: 1.8-16.2), previous valve surgery (HR: 4.5, 95{\%} CI: 1.7-12.2), tricuspid regurgitation (TR) ≥ grade 3 prior to MCI (HR: 2.8, 95{\%} CI: 1.2-6.8) and absence of MR reduction after MCI (HR: 2.1, 95{\%} CI: 1.2-3.8). The 2-year survival of patients with 0, 1 or ≥2 of these predictors was: 87{\%}; 78{\%} and 38{\%} respectively (log-rank p <0.001). The functional class at 1 month and mid-term follow-up was worse in patients with two or more of these predictors present at baseline compared to patients with zero or one of these predictors (1 month: p = 0.007 and mid-term: p <0.001). Conclusion: Heart failure, previous valve surgery, co-presence of TR and the degree of MR reduction after MCI are the independent predictors of survival and functional status after MCI in high risk patients. The pre-procedural characteristics may be used to optimize patient selection, while maximal MR reduction should be attempted to optimize the outcome of MCI.",
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author = "Kirsten Boerlage-vanDijk and Wiegerinck, {Esther M A} and Motoharu Araki and Meregalli, {Paola G.} and Bindraban, {Navin R.} and Koch, {Karel T.} and Vis, {M. Marije} and Piek, {Jan J.} and Tijssen, {Jan G P} and Bouma, {Berto J.} and Jan Baan",
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T2 - An aid to improve patient selection

AU - Boerlage-vanDijk, Kirsten

AU - Wiegerinck, Esther M A

AU - Araki, Motoharu

AU - Meregalli, Paola G.

AU - Bindraban, Navin R.

AU - Koch, Karel T.

AU - Vis, M. Marije

AU - Piek, Jan J.

AU - Tijssen, Jan G P

AU - Bouma, Berto J.

AU - Baan, Jan

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N2 - Background: MitraClip implantation (MCI) reduces mitral regurgitation (MR) and symptoms in patients considered inoperable or with high-surgical risk. Data to determine the benefit from MCI for an individual patient are limited. The aim of this study is to determine predictors associated with the prognosis after MCI to improve the patient selection for this procedure. Methods: We included 84 consecutive patients (age: 76 ± 10 years, 51% male) who underwent MCI in our institution for symptomatic severe MR. All patients underwent transthoracic echocardiography before MCI; clinical and echocardiographic follow-up was obtained after MCI. Results: The 2-year survival was 81%. Predictors for two-year mortality in multi-variate analysis were baseline NT-proBNP ≥ 5000 μg/L (HR: 5.4, 95% CI: 1.8-16.2), previous valve surgery (HR: 4.5, 95% CI: 1.7-12.2), tricuspid regurgitation (TR) ≥ grade 3 prior to MCI (HR: 2.8, 95% CI: 1.2-6.8) and absence of MR reduction after MCI (HR: 2.1, 95% CI: 1.2-3.8). The 2-year survival of patients with 0, 1 or ≥2 of these predictors was: 87%; 78% and 38% respectively (log-rank p <0.001). The functional class at 1 month and mid-term follow-up was worse in patients with two or more of these predictors present at baseline compared to patients with zero or one of these predictors (1 month: p = 0.007 and mid-term: p <0.001). Conclusion: Heart failure, previous valve surgery, co-presence of TR and the degree of MR reduction after MCI are the independent predictors of survival and functional status after MCI in high risk patients. The pre-procedural characteristics may be used to optimize patient selection, while maximal MR reduction should be attempted to optimize the outcome of MCI.

AB - Background: MitraClip implantation (MCI) reduces mitral regurgitation (MR) and symptoms in patients considered inoperable or with high-surgical risk. Data to determine the benefit from MCI for an individual patient are limited. The aim of this study is to determine predictors associated with the prognosis after MCI to improve the patient selection for this procedure. Methods: We included 84 consecutive patients (age: 76 ± 10 years, 51% male) who underwent MCI in our institution for symptomatic severe MR. All patients underwent transthoracic echocardiography before MCI; clinical and echocardiographic follow-up was obtained after MCI. Results: The 2-year survival was 81%. Predictors for two-year mortality in multi-variate analysis were baseline NT-proBNP ≥ 5000 μg/L (HR: 5.4, 95% CI: 1.8-16.2), previous valve surgery (HR: 4.5, 95% CI: 1.7-12.2), tricuspid regurgitation (TR) ≥ grade 3 prior to MCI (HR: 2.8, 95% CI: 1.2-6.8) and absence of MR reduction after MCI (HR: 2.1, 95% CI: 1.2-3.8). The 2-year survival of patients with 0, 1 or ≥2 of these predictors was: 87%; 78% and 38% respectively (log-rank p <0.001). The functional class at 1 month and mid-term follow-up was worse in patients with two or more of these predictors present at baseline compared to patients with zero or one of these predictors (1 month: p = 0.007 and mid-term: p <0.001). Conclusion: Heart failure, previous valve surgery, co-presence of TR and the degree of MR reduction after MCI are the independent predictors of survival and functional status after MCI in high risk patients. The pre-procedural characteristics may be used to optimize patient selection, while maximal MR reduction should be attempted to optimize the outcome of MCI.

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