Abstract
BackgroundHepatorenal dysfunction is a strong prognostic predictor in patients with heart failure. However, the prognostic impact of the hepatorenal dysfunction in patients undergoing transcatheter mitral valve repair (TMVR) has not been well studied.MethodsIn consecutive patients who underwent edge-to-edge TMVR at three German centers, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln [serum total bilirubin (mg/dl)] + 11.76 × ln [serum creatinine (mg/dl)] + 9.44. Patients were stratified into high (> 11) or low (≤ 11) MELD-XI score of which an incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within 2 years after TMVR was assessed.ResultsOf the 881 patients, the mean MELD-XI score was 11.0 ± 5.9, and 415 patients (47.1%) had high MELD-XI score. The MELD-XI score was correlated with male, effective regurgitant orifice area, and tricuspid regurgitation severity and inversely related to left ventricular ejection fraction. Patients with high MELD-XI score had a higher incidence of the composite outcome than those with low MELD-XI score (47.7% vs. 29.8%; p < 0.0001), and in multivariable analysis, the high MELD-XI score was an independent predictor of the composite outcome [adjusted hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.02–1.77; p = 0.04). Additionally, the MELD-XI score as a continuous variable was also an independent predictor (adjusted HR 1.02; 95% CI 1.00–1.05; p = 0.048).ConclusionsThe MELD-XI score was associated with clinical outcomes within 2 years after TMVR and can be a useful risk-stratification tool in patients undergoing TMVR.
Highlights
Hepatorenal dysfunction is a strong prognostic predictor in patients with heart failure
The mean left ventricular ejection fraction (LVEF) was 44.6 ± 15.1%, and functional mitral regurgitation (MR) was the etiology of MR in 61% of the patients
In the current multicenter study of patients undergoing to-edge mitral valve repair (TMVR), the main findings can be summarized as follows: (1) the MELD-XI score, as both continuous and dichotomous variable, was associated with a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure (HF) hospitalization, within 2 years after TMVR, independent of MR etiology; (2) the MELD-XI score had a higher predictive value of the composite outcome compared to total bilirubin and eGFR; (3) the MELD-XI score was correlated to male sex, MR EROA, and tricuspid regurgitation (TR) severity, and inversely to LVEF; and (4) the risk of the composite outcome increased in the MELD-XI score of greater than 11, whereas the association of the MELD-XI score with clinical outcome was not observed in the MELD-XI score of less than 11
Summary
Hepatorenal dysfunction is a strong prognostic predictor in patients with heart failure. Methods In consecutive patients who underwent edge-to-edge TMVR at three German centers, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln [serum total bilirubin (mg/ dl)] + 11.76 × ln [serum creatinine (mg/dl)] + 9.44. It has been reported that the presence of hepatic or renal dysfunction is a strong predictor of adverse clinical events in patients with heart failure (HF). The Model for End-stage Liver Disease excluding international normalized ratio score (MELDXI) is one of the scoring models that have been widely used for assessment of renal and hepatic function [4]. Previous reports showed the prognostically predictive value of the MELD-XI score in patients with HF [5,6,7,8]
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