Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair

Leor Perl; Mark Kheifets; MITRA-EF study; Ascione Guido; Eustachio Agricola; Paolo Denti; Mirjam Gauri Wild; Fabien Praz; Antonio Popolo Rubbio; Francesco Bedogni; Federico De Marco; Ronen Beeri; Mony Shuvy; Francesco Melillo; Matteo Montorfano; Xavier Freixa; Juan Carlos de la Fuente Mancera; Arturo Giordano; Filippo Finizio; Nicolas M. Van Mieghem; J. F.W. Ooms; Neil Fam; Cormac O’connor; Stefan Toggweiler; Amos Levi; Yaron Shapira; Shmuel Schwartzenberg; Stefano Pidello; Fabrizio D’ascenzo; Filippo Angelini; Dan Haberman; Gabriele Crimi; Italo Porto; Ottavia Cozzi; Francesco Giannini; Giuseppe Tarantini; Francesco Maisano; Ran Kornowski

doi:10.1161/JAHA.123.029735

Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair

Leor Perl^*
, Mark Kheifets
, MITRA-EF study
, Ascione Guido
, Eustachio Agricola
, Paolo Denti
, Mirjam Gauri Wild
, Fabien Praz
, Antonio Popolo Rubbio
, Francesco Bedogni
, Federico De Marco
, Ronen Beeri
, Mony Shuvy
, Francesco Melillo
, Matteo Montorfano
, Xavier Freixa
, Juan Carlos de la Fuente Mancera
, Arturo Giordano
, Filippo Finizio
, Nicolas M. Van Mieghem

J. F.W. Ooms, Neil Fam, Cormac O’connor, Stefan Toggweiler, Amos Levi, Yaron Shapira, Shmuel Schwartzenberg, Stefano Pidello, Fabrizio D’ascenzo, Filippo Angelini, Dan Haberman, Gabriele Crimi, Italo Porto, Ottavia Cozzi, Francesco Giannini, Giuseppe Tarantini, Francesco Maisano, Ran Kornowski

^*Corresponding author for this work

Cardiology

Tel Aviv University
Vita-Salute San Raffaele University
University Heart Center Freiburg-Bad Krozingen
University Hospital Bern
Gruppo Ospedaliero San Donato
IRCCS Centro Cardiologico S.P.A. Fondazione Monzino - Milano
Hadassah University Medical Centre
Hebrew University of Jerusalem
University of Barcelona
Pineta Grande Hospital
University of Toronto
Kantonsspital Luzern
University of Turin
University of Genoa
IRCCS Istituto Clinico Humanitas - Rozzano (Milano)
GVM Care and Research S.p.A.
University of Padua

Research output: Contribution to journal › Article › Academic › peer-review

34 Citations (Scopus)

80 Downloads (Pure)

Abstract

BACKGROUND: Little is known about the impact of transcatheter mitral valve edge-to-edge repair on changes in left ventricular ejection fraction (LVEF) and the effect of an acute reduction in LVEF on prognosis. We aimed to assess changes in LVEF after transcatheter mitral valve edge-to-edge repair for both primary and secondary mitral regurgitation (PMR and SMR, respectively), identify rates and predictors of LVEF reduction, and estimate its impact on prognosis. METHODS AND RESULTS: In this international multicenter registry, patients with both PMR and SMR undergoing transcatheter mitral valve edge-to-edge repair were included. We assessed rates of acute LVEF reduction (LVEFR), defined as an acute relative decrease of >15% in LVEF, its impact on all-cause mortality, major adverse cardiac event (composite end point of all-cause death, mitral valve surgery, and residual mitral regurgitation grade ≥2), and LVEF at 12 months, as well as predictors for LVEFR. Of 2534 patients included (727 with PMR, and 1807 with SMR), 469 (18.5%) developed LVEFR. Patients with PMR were older (79.0±9.2 versus 71.8±8.9 years; P<0.001) and had higher mean LVEF (54.8±14.0% versus 32.7±10.4%; P<0.001) at baseline. After 6 to 12 months (median, 9.9 months; interquartile range, 7.8–11.9 months), LVEF was significantly lower in patients with PMR (53.0% versus 56.0%; P<0.001) but not in patients with SMR. The 1-year mortality was higher in patients with PMR with LVEFR (16.9% versus 9.7%; P<0.001) but not in those with SMR (P=0.236). LVEF at baseline (odds ratio, 1.03 [95% CI, 1.01– 1.05]; P=0.002) was predictive of LVEFR for patients with PMR, but not those with SMR (P=0.092). CONCLUSIONS: Reduction in LVEF is not uncommon after transcatheter mitral valve edge-to-edge repair and is correlated with worsened prognosis in patients with PMR but not patients with SMR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05311163.

Original language	English
Article number	e029735
Journal	Journal of the American Heart Association
Volume	12
Issue number	13
DOIs	https://doi.org/10.1161/JAHA.123.029735
Publication status	Published - 4 Jul 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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10.1161/JAHA.123.029735Licence: CC BY-NC-ND

JAHA.123.029735Final published version, 1.63 MBLicence: CC BY-NC-ND

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Perl, L., Kheifets, M., MITRA-EF study, Guido, A., Agricola, E., Denti, P., Wild, M. G., Praz, F., Rubbio, A. P., Bedogni, F., De Marco, F., Beeri, R., Shuvy, M., Melillo, F., Montorfano, M., Freixa, X., de la Fuente Mancera, J. C., Giordano, A., Finizio, F., ... Kornowski, R. (2023). Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair. Journal of the American Heart Association, 12(13), Article e029735. https://doi.org/10.1161/JAHA.123.029735

@article{47a24ab492a24f529e68f9866dcb9026,

title = "Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair",

abstract = "BACKGROUND: Little is known about the impact of transcatheter mitral valve edge-to-edge repair on changes in left ventricular ejection fraction (LVEF) and the effect of an acute reduction in LVEF on prognosis. We aimed to assess changes in LVEF after transcatheter mitral valve edge-to-edge repair for both primary and secondary mitral regurgitation (PMR and SMR, respectively), identify rates and predictors of LVEF reduction, and estimate its impact on prognosis. METHODS AND RESULTS: In this international multicenter registry, patients with both PMR and SMR undergoing transcatheter mitral valve edge-to-edge repair were included. We assessed rates of acute LVEF reduction (LVEFR), defined as an acute relative decrease of >15\% in LVEF, its impact on all-cause mortality, major adverse cardiac event (composite end point of all-cause death, mitral valve surgery, and residual mitral regurgitation grade ≥2), and LVEF at 12 months, as well as predictors for LVEFR. Of 2534 patients included (727 with PMR, and 1807 with SMR), 469 (18.5\%) developed LVEFR. Patients with PMR were older (79.0±9.2 versus 71.8±8.9 years; P<0.001) and had higher mean LVEF (54.8±14.0\% versus 32.7±10.4\%; P<0.001) at baseline. After 6 to 12 months (median, 9.9 months; interquartile range, 7.8–11.9 months), LVEF was significantly lower in patients with PMR (53.0\% versus 56.0\%; P<0.001) but not in patients with SMR. The 1-year mortality was higher in patients with PMR with LVEFR (16.9\% versus 9.7\%; P<0.001) but not in those with SMR (P=0.236). LVEF at baseline (odds ratio, 1.03 [95\% CI, 1.01– 1.05]; P=0.002) was predictive of LVEFR for patients with PMR, but not those with SMR (P=0.092). CONCLUSIONS: Reduction in LVEF is not uncommon after transcatheter mitral valve edge-to-edge repair and is correlated with worsened prognosis in patients with PMR but not patients with SMR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05311163.",

author = "Leor Perl and Mark Kheifets and \{MITRA-EF study\} and Ascione Guido and Eustachio Agricola and Paolo Denti and Wild, \{Mirjam Gauri\} and Fabien Praz and Rubbio, \{Antonio Popolo\} and Francesco Bedogni and \{De Marco\}, Federico and Ronen Beeri and Mony Shuvy and Francesco Melillo and Matteo Montorfano and Xavier Freixa and \{de la Fuente Mancera\}, \{Juan Carlos\} and Arturo Giordano and Filippo Finizio and \{Van Mieghem\}, \{Nicolas M.\} and Ooms, \{J. F.W.\} and Neil Fam and Cormac O{\textquoteright}connor and Stefan Toggweiler and Amos Levi and Yaron Shapira and Shmuel Schwartzenberg and Stefano Pidello and Fabrizio D{\textquoteright}ascenzo and Filippo Angelini and Dan Haberman and Gabriele Crimi and Italo Porto and Ottavia Cozzi and Francesco Giannini and Giuseppe Tarantini and Francesco Maisano and Ran Kornowski",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",

year = "2023",

month = jul,

day = "4",

doi = "10.1161/JAHA.123.029735",

language = "English",

volume = "12",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "American Heart Association Inc.",

number = "13",

}

Perl, L, Kheifets, M, MITRA-EF study, Guido, A, Agricola, E, Denti, P, Wild, MG, Praz, F, Rubbio, AP, Bedogni, F, De Marco, F, Beeri, R, Shuvy, M, Melillo, F, Montorfano, M, Freixa, X, de la Fuente Mancera, JC, Giordano, A, Finizio, F, Van Mieghem, NM, Ooms, JFW, Fam, N, O’connor, C, Toggweiler, S, Levi, A, Shapira, Y, Schwartzenberg, S, Pidello, S, D’ascenzo, F, Angelini, F, Haberman, D, Crimi, G, Porto, I, Cozzi, O, Giannini, F, Tarantini, G, Maisano, F & Kornowski, R 2023, 'Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair', Journal of the American Heart Association, vol. 12, no. 13, e029735. https://doi.org/10.1161/JAHA.123.029735

TY - JOUR

T1 - Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair

AU - Perl, Leor

AU - Kheifets, Mark

AU - MITRA-EF study

AU - Guido, Ascione

AU - Agricola, Eustachio

AU - Denti, Paolo

AU - Wild, Mirjam Gauri

AU - Praz, Fabien

AU - Rubbio, Antonio Popolo

AU - Bedogni, Francesco

AU - De Marco, Federico

AU - Beeri, Ronen

AU - Shuvy, Mony

AU - Melillo, Francesco

AU - Montorfano, Matteo

AU - Freixa, Xavier

AU - de la Fuente Mancera, Juan Carlos

AU - Giordano, Arturo

AU - Finizio, Filippo

AU - Van Mieghem, Nicolas M.

AU - Ooms, J. F.W.

AU - Fam, Neil

AU - O’connor, Cormac

AU - Toggweiler, Stefan

AU - Levi, Amos

AU - Shapira, Yaron

AU - Schwartzenberg, Shmuel

AU - Pidello, Stefano

AU - D’ascenzo, Fabrizio

AU - Angelini, Filippo

AU - Haberman, Dan

AU - Crimi, Gabriele

AU - Porto, Italo

AU - Cozzi, Ottavia

AU - Giannini, Francesco

AU - Tarantini, Giuseppe

AU - Maisano, Francesco

AU - Kornowski, Ran

PY - 2023/7/4

Y1 - 2023/7/4

N2 - BACKGROUND: Little is known about the impact of transcatheter mitral valve edge-to-edge repair on changes in left ventricular ejection fraction (LVEF) and the effect of an acute reduction in LVEF on prognosis. We aimed to assess changes in LVEF after transcatheter mitral valve edge-to-edge repair for both primary and secondary mitral regurgitation (PMR and SMR, respectively), identify rates and predictors of LVEF reduction, and estimate its impact on prognosis. METHODS AND RESULTS: In this international multicenter registry, patients with both PMR and SMR undergoing transcatheter mitral valve edge-to-edge repair were included. We assessed rates of acute LVEF reduction (LVEFR), defined as an acute relative decrease of >15% in LVEF, its impact on all-cause mortality, major adverse cardiac event (composite end point of all-cause death, mitral valve surgery, and residual mitral regurgitation grade ≥2), and LVEF at 12 months, as well as predictors for LVEFR. Of 2534 patients included (727 with PMR, and 1807 with SMR), 469 (18.5%) developed LVEFR. Patients with PMR were older (79.0±9.2 versus 71.8±8.9 years; P<0.001) and had higher mean LVEF (54.8±14.0% versus 32.7±10.4%; P<0.001) at baseline. After 6 to 12 months (median, 9.9 months; interquartile range, 7.8–11.9 months), LVEF was significantly lower in patients with PMR (53.0% versus 56.0%; P<0.001) but not in patients with SMR. The 1-year mortality was higher in patients with PMR with LVEFR (16.9% versus 9.7%; P<0.001) but not in those with SMR (P=0.236). LVEF at baseline (odds ratio, 1.03 [95% CI, 1.01– 1.05]; P=0.002) was predictive of LVEFR for patients with PMR, but not those with SMR (P=0.092). CONCLUSIONS: Reduction in LVEF is not uncommon after transcatheter mitral valve edge-to-edge repair and is correlated with worsened prognosis in patients with PMR but not patients with SMR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05311163.

AB - BACKGROUND: Little is known about the impact of transcatheter mitral valve edge-to-edge repair on changes in left ventricular ejection fraction (LVEF) and the effect of an acute reduction in LVEF on prognosis. We aimed to assess changes in LVEF after transcatheter mitral valve edge-to-edge repair for both primary and secondary mitral regurgitation (PMR and SMR, respectively), identify rates and predictors of LVEF reduction, and estimate its impact on prognosis. METHODS AND RESULTS: In this international multicenter registry, patients with both PMR and SMR undergoing transcatheter mitral valve edge-to-edge repair were included. We assessed rates of acute LVEF reduction (LVEFR), defined as an acute relative decrease of >15% in LVEF, its impact on all-cause mortality, major adverse cardiac event (composite end point of all-cause death, mitral valve surgery, and residual mitral regurgitation grade ≥2), and LVEF at 12 months, as well as predictors for LVEFR. Of 2534 patients included (727 with PMR, and 1807 with SMR), 469 (18.5%) developed LVEFR. Patients with PMR were older (79.0±9.2 versus 71.8±8.9 years; P<0.001) and had higher mean LVEF (54.8±14.0% versus 32.7±10.4%; P<0.001) at baseline. After 6 to 12 months (median, 9.9 months; interquartile range, 7.8–11.9 months), LVEF was significantly lower in patients with PMR (53.0% versus 56.0%; P<0.001) but not in patients with SMR. The 1-year mortality was higher in patients with PMR with LVEFR (16.9% versus 9.7%; P<0.001) but not in those with SMR (P=0.236). LVEF at baseline (odds ratio, 1.03 [95% CI, 1.01– 1.05]; P=0.002) was predictive of LVEFR for patients with PMR, but not those with SMR (P=0.092). CONCLUSIONS: Reduction in LVEF is not uncommon after transcatheter mitral valve edge-to-edge repair and is correlated with worsened prognosis in patients with PMR but not patients with SMR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05311163.

UR - https://www.scopus.com/pages/publications/85164242190

U2 - 10.1161/JAHA.123.029735

DO - 10.1161/JAHA.123.029735

M3 - Article

C2 - 37345813

AN - SCOPUS:85164242190

SN - 2047-9980

VL - 12

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 13

M1 - e029735

ER -

Acute Reduction in Left Ventricular Function Following Transcatheter Mitral Edge-to-Edge Repair

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