Abstract
The Get-With-The-Guidelines-Heart-Failure (GWTG-HF) score is a risk assessment tool to predict mortality in patients with heart-failure (HF). We aimed to evaluate the GWTG-HF score for risk stratification in HF patients with tricuspid regurgitation undergoing trans-catheter tricuspid valve repair (TTVR). In total, 181 patients who underwent TTVR via edge-to-edge repair (86%) or annuloplasty (14%) were enrolled. Patients were categorized into a low- (≤ 43 points), intermediate- (44–53 points) and high-risk score groups (≥ 54 points). TTVR led to an improvement of TR (p < 0.0001) and NYHA (p < 0.0001). Kaplan–Meier analysis and log-rank test revealed that higher GWTG-HF scores were associated with reduced rates of event-free survival regarding mortality (96% vs 89% vs 73%, respectively, p = 0.001) and hospitalization for heart failure (HHF) (89% vs 86% vs 74%, respectively, p = 0.026). After adjusting for important variables like renal function, left ventricular ejection fraction and mitral regurgitation, the GWTG-HF score remained an independent predictor of the composite endpoint of HHF or mortality (hazard ratio 1.04 per 1-point increase, p = 0.029). Other remaining predictors were renal function and mitral regurgitation. The GWTG-HF score used as a risk stratification tool of mortality and HHF maintains its prognostic value in a HF population with severe TR undergoing TTVR.
Highlights
Trans-catheter repair of severe tricuspid regurgitation (TR) is an emerging field, representing a minimal-invasive alternative to tricuspid valve surgery, which is associated with poor morbidity and mortality rates [1]
After adjusting for clinically important variables including LVEF, mitral regurgitation and glomerular filtration rate, the Get-with-The-Guidelines-Heart Failure (GWTG-heart failure (HF)) score remained an independent predictor of the combined endpoint of hospitalization for heart failure (HHF) and mortality
We demonstrate (1) that trans-catheter tricpuspid valve repair (TTVR) including trans-catheter edge-to-edge repair and annuloplasty was feasible in the majority of patients and effective in substantial improvement of TR and New York Heart Association (NYHA) class; (2) that patients displayed a worse event-free survival with increasing GWTG-HF score categorization, regarding mortality, HHF and the combined endpoint composite of both; (3) that each 1-point increase in the GWTG-HF score was independently associated with a 4% increase in the risk for the composite endpoint of mortality and HHF, after adjusting for parameters including LVEF, mitral regurgitation and renal function; and (4) that the high predictive power of the GWTG-HF score regarding outcome could be improved by the inclusion of NT-proBNP levels
Summary
Trans-catheter repair of severe tricuspid regurgitation (TR) is an emerging field, representing a minimal-invasive alternative to tricuspid valve surgery, which is associated with poor morbidity and mortality rates [1]. The Get-with-The-Guidelines-Heart Failure (GWTG-HF) risk score was initially introduced for prediction of in-hospital mortality in acute heart failure (HF) patients [6]. The GWTG-HF score demonstrated its use for risk stratification in patients with chronic HF and regarding post-discharge events [8, 9]. A recent study revealed a high correlation of this score with prognosis in patients undergoing trans-catheter mitral valve repair [10]. Due to their close interaction, TR is common in HF and portends poor prognosis [11].
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