Abstract
BackgroundReliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients.MethodsConsecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality.ResultsAmong 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0–37; 38–42, 43–46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06–1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation.ConclusionThe “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible.Graphic abstract
Highlights
Transcatheter mitral valve repair (TMVR) with MitraClip is a recommended treatment for selected patients with primary and secondary mitral regurgitation (MR) and high or prohibitive surgical risk [1]
The association of the GWTG-HF score with mortality was attenuated but remained significant when adjusting for other measures of heart failure severity such as NYHA class, left-ventricular ejection fraction, NT-pro-BNP and previous hospitalization of heart failure (HR 1.06, 95% CI 1.03–1.09, p < 0.001)
In the present study we investigated the performance of the GWTG-HF score for mortality prediction in patients undergoing to-edge mitral valve repair (TMVR) with the MitraClip system
Summary
Transcatheter mitral valve repair (TMVR) with MitraClip is a recommended treatment for selected patients with primary and secondary mitral regurgitation (MR) and high or prohibitive surgical risk [1]. Outcome after TMVR is impaired due to severe cardiac and noncardiac morbidities [4] Risk stratification in these patients is important for informed decision making of physicians, patients and relatives. Reliable risk stratification in patients undergoing TMVR is lacking. Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Methods Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. Conclusion The “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible
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