The goal of this study was to determine the predictors of adverse clinical outcomes
in patients treated with the MitraClip for significant mitral regurgitation (MR) with
a focus on acute changes in hemodynamics and cardiac function. This retrospective
study included 63 patients (mean age 82 ± 8 years, 48% male) with moderate to severe
or severe MR. Cardiac catheterization was performed before and immediately after MitraClip
repair. Volumetric and functional changes were assessed in both ventricles. A major
adverse cardiac event was defined as a composite of cardiac death and readmission
for heart failure. Patients were followed up on average for 380 days. MR was improved
in 92% of patients after MitraClip therapy from an average grade of 4+ to <2+ (p <0.001).
The pulmonary capillary wedge pressure decreased from 22 ± 7 mm Hg to 19 ± 6 mm Hg
(p <0.001), and the cardiac stroke volume increased by 28% from 102 ± 53 ml to 131
± 54 ml (p <0.001). The left ventricular end-diastolic volume was significantly reduced
24 hours after MitraClip therapy compared to that at baseline (p = 0.001). In the
multivariate Cox proportion hazard regression model, an age ≥85 years (p <0.001) and
residual MR >1+ (p <0.048) were predictors of an adverse prognosis at follow-up. In
conclusion, a reduced left ventricular end-diastolic volume and improved hemodynamics
occurred early after MitraClip therapy. An advanced age (≥85 years) and residual MR
>1+ were associated with an increased risk of mortality and heart failure.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 13,
2019
Received:
March 30,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
