Abstract
The preprocedural assessment of outcomes and patients' prognosis after interventional therapy of functional MR (FMR) is uncertain. Therefore, we aim to develop an easy-to-handle scoring system for adequate prediction of individual outcomes in patients with FMR after the interventional treatment. We retrospectively used medical data of patients with symptomatic FMR, who underwent transcatheter mitral valve repair (TMVR) from January 2014 to August 2016 in our heart center. All patients had the mean follow-up of 18 months. All clinical and echocardiographic data originate from the "Bonner Mitral Valve Register Database". We included 105 patients (76,7±8,8 years, 50,6% female) with symptomatic (NYHA functional class>II) moderate-to-severe or severe FMR at surgical high-risk. We modified the MIDA-Score for degenerative MR (DMR) according to the varying underlying pathomechanisms of FMR, called as "The modified MIDA Score". We found all-cause mortality of 7% within 18 months after the procedure. 34,1% of our cohort was rehospitalized; 90% of those were due to cardiovascular causes. The modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0,89) and superior to the other conventional scoring systems in prediction of mortality (The modified MIDA-Score: AUC: 0,8, EuroSCORE II: AUC: 0,57, STS-Score: AUC: 0,51). The logistic regression analysis showed the modified MIDA score > 9 points to be the strongest predictor for mortality and rehospitalization after TMVR (OR: 3,35, p = 0,011). The modified MIDA score was found to be a promising, easy-to-handle, elementary scoring system for adequate prediction of individual postinterventional prognosis in patients with FMR undergoing TMVR. Further evaluation and validation of this novel scoring system in prospective multicentric studies with a large number of patients is warranted.
Highlights
Mitral regurgitation (MR) is common valvular heart disease and associated with high mortality and reduced quality of life
We modified the Mitral Regurgitation International Database (MIDA)-Score for degenerative MR (DMR) according to the varying underlying pathomechanisms of functional MR (FMR), called as “The modified MIDA Score”
The modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0,89) and superior to the other conventional scoring systems in prediction of mortality (The modified MIDA-Score: area under the curve (AUC): 0,8, EuroSCORE II: AUC: 0,57, STS-Score: AUC: 0,51)
Summary
Mitral regurgitation (MR) is common valvular heart disease and associated with high mortality and reduced quality of life. Functional MR (FMR) is a disease of the left ventricle, which is accompanied by ventricular dilation, displacement of papillary muscle, and annular dilation followed by tethering of the leaflets and coaptation deficiency without any organic pathology of the mitral valve. FMR is an often finding in patients with chronic heart failure (CHF) and correlates with adverse prognosis, reduced quality of life, and high mortality [1]. The standard treatment of FMR consists of guidelines-directed optimal medical heart failure therapy, cardiac resynchronization therapy (if appropriate), and valve repair or replacement (surgical or interventional) [2]. Transcatheter mitral valve repair (TMVR) has been established in clinical practice and is increasingly and successfully performed in patients at surgical high-risk [3], [4], [5]
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