Advertisement

Effect of Chronic Kidney Disease on 5-Year Outcome in Patients With Heart Failure and Secondary Mitral Regurgitation Undergoing Percutaneous MitraClip Insertion

      Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60 ml/min/1.73 m2) (n = 196), mild-to-moderate CKD (30 to 59 ml/min/1.73 m2) (n = 267), and severe CKD (<30 ml/min/1.73 m2) (n = 102). The primary end point was a composite of overall death and the first rehospitalization for HF, the secondary end points were overall death, cardiac death, and first rehospitalization for HF. CKD was present in about 2/3 of patients. At 5-year Kaplan–Meier analysis, primary clinical end point occurred in 60% of patients with normal eGFR, compared with 73% cases in patients with mild-to-moderate CKD and 91% in patients with severe CKD (p <0.001). Long-term overall death rate significantly decreased with increasing eGFR, and cardiac death and rehospitalization for HF rates. Multivariate Cox regression analysis identified severe CKD as the strongest independent predictor of adverse outcome (hazard ratio 2.136, 95% confidence interval 1.164 to 3.918, p = 0.014). In conclusion, CKD affected about 2/3 of patients who underwent MitraClip treatment for severe SMR, and it was a strong and independent predictor of 5-year adverse outcomes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mack MJ
        • Lindenfeld J
        • Abraham WT
        • Kar S
        • Lim DS
        • Mishell JM
        • Whisenant BK
        • Grayburn PA
        • Rinaldi MJ
        • Kapadia SR
        • Rajagopal V
        • Sarembock IJ
        • Brieke A
        • Rogers JH
        • Marx SO
        • Cohen DJ
        • Weissman NJ
        • Stone GW
        • COAPT Investigators
        3-year outcomes of transcatheter mitral valve repair in patients with heart failure.
        J Am Coll Cardiol. 2021; 77: 1029-1040
        • Stone GW
        • Lindenfeld J
        • Abraham WT
        • Kar S
        • Lim DS
        • Mishell JM
        • Whisenant B
        • Grayburn PA
        • Rinaldi M
        • Kapadia SR
        • Rajagopal V
        • Sarembock IJ
        • Brieke A
        • Marx SO
        • Cohen DJ
        • Weissman NJ
        • Mack MJ
        • COAPT Investigators
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Obadia JF
        • Messika-Zeitoun D
        • Leurent G
        • Iung B
        • Bonnet G
        • Piriou N
        • Lefèvre T
        • Piot C
        • Rouleau F
        • Carrié D
        • Nejjari M
        • Ohlmann P
        • Leclercq F
        • Saint Etienne C
        • Teiger E
        • Leroux L
        • Karam N
        • Michel N
        • Gilard M
        • Donal E
        • Trochu JN
        • Cormier B
        • Armoiry X
        • Boutitie F
        • Maucort-Boulch D
        • Barnel C
        • Samson G
        • Guerin P
        • Vahanian A
        • Mewton N
        • MITRA-FR Investigators
        Percutaneous repair or medical treatment for secondary mitral regurgitation.
        N Engl J Med. 2018; 379: 2297-2306
        • Godino C
        • Munafò A
        • Sisinni A
        • Margonato A
        • Saia F
        • Montorfano M
        • Agricola E
        • Alfieri O
        • Colombo A
        • Senni M.
        MitraClip Treatment of Secondary Mitral Regurgitation in Heart Failure with Reduced Ejection Fraction: Lessons and Implications from Trials and Registries.
        Structural Heart. 2020; 4: 247-253
        • Iung B
        • Armoiry X
        • Vahanian A
        • Boutitie F
        • Mewton N
        • Trochu JN
        • Lefèvre T
        • Messika-Zeitoun D
        • Guerin P
        • Cormier B
        • Brochet E
        • Thibault H
        • Himbert D
        • Thivolet S
        • Leurent G
        • Bonnet G
        • Donal E
        • Piriou N
        • Piot C
        • Habib G
        • Rouleau F
        • Carrié D
        • Nejjari M
        • Ohlmann P
        • Saint Etienne C
        • Leroux L
        • Gilard M
        • Samson G
        • Rioufol G
        • Maucort-Boulch D
        • Obadia JF
        • MITRA-FR Investigators
        Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years.
        Eur J Heart Fail. 2019; 21: 1619-1627
        • Kalbacher D
        • Schäfer U
        • Bardeleben VRS
        • Eggebrecht H
        • Sievert H
        • Nickenig G
        • Butter C
        • May AE
        • Bekeredjian R
        • Ouarrak T
        • Kuck KH
        • Plicht B
        • Zahn R
        • Baldus S
        • Ince H
        • Schillinger W
        • Boekstegers P
        • Senges J
        • Lubos E.
        Long-term outcome, survival and predictors of mortality after MitraClip therapy: Results from the German Transcatheter Mitral Valve Interventions (TRAMI) registry.
        Int J Cardiol. 2019; 277: 35-41
        • Maisano F
        • Franzen O
        • Baldus S
        • Schäfer U
        • Hausleiter J
        • Butter C
        • Ussia GP
        • Sievert H
        • Richardt G
        • Widder JD
        • Moccetti T
        • Schillinger W.
        Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe.
        J Am Coll Cardiol. 2013; 62: 1052-1061
        • Shiba N
        • Shimokawa H.
        Chronic kidney disease and heart failure–Bidirectional close link and common therapeutic goal.
        J Cardiol. 2011; 57: 8-17
        • House AA
        • Wanner C
        • Sarnak MJ
        • Piña IL
        • McIntyre CW
        • Komenda P
        • Kasiske BL
        • Deswal A
        • deFilippi CR
        • Cleland JGF
        • Anker SD
        • Herzog CA
        • Cheung M
        • Wheeler DC
        • Winkelmayer WC
        • McCullough PA
        Conference Participants. Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
        Kidney Int. 2019; 95: 1304-1317
        • Rangaswami J
        • Bhalla V
        • Blair JEA
        • Chang TI
        • Costa S
        • Lentine KL
        • Lerma EV
        • Mezue K
        • Molitch M
        • Mullens W
        • Ronco C
        • Tang WHW
        • McCullough PA
        American Heart Association Council on the Kidney in Cardiovascular Disease and Council on Clinical Cardiology. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: A scientific statement from the American Heart Association.
        Circulation. 2019; 139: e840-e878
        • Kaneko H
        • Neuss M
        • Schau T
        • Weissenborn J
        • Butter C.
        Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip.
        J Cardiol. 2017; 69: 476-482
        • Wang A
        • Sangli C
        • Lim S
        • Ailawadi G
        • Kar S
        • Herrmann HC
        • Grayburn P
        • Foster E
        • Weissman NJ
        • Glower D
        • Feldman T.
        Evaluation of renal function before and after percutaneous mitral valve repair.
        Circ Cardiovasc Interv. 2015; 8e001349
        • Estévez-Loureiro R
        • Settergren M
        • Pighi M
        • Winter R
        • D'Allara G
        • Jacobsen P
        • Sondergaard L
        • Cheung G
        • Ghione M
        • Ihlemann N
        • Moat NE
        • Price S
        • Rosenberg TS
        • Di Mario C
        • Franzen O
        Effect of advanced chronic kidney disease in clinical and echocardiographic outcomes of patients treated with MitraClip system.
        Int J Cardiol. 2015; 198: 75-80
        • Ohno Y
        • Attizzani GF
        • Capodanno D
        • Barbanti M
        • Cannata S
        • Dipasqua F
        • Immé S
        • Ministeri M
        • Caggegi A
        • Pistritto AM
        • Chiarandà M
        • Ronsivalle G
        • Giaquinta S
        • Mangiafico S
        • Scandura S
        • Capranzano P
        • Tamburino C
        • Grasso C.
        Impact of chronic kidney disease on outcomes after percutaneous mitral valve repair with the MitraClip system: insights from the GRASP registry.
        EuroIntervention. 2016; 11: e1649-e1657
        • Ponikowski P
        • Voors AA
        • Anker SD
        • Bueno H
        • Cleland JGF
        • Coats AJS
        • Falk V
        • González-Juanatey JR
        • Harjola VP
        • Jankowska EA
        • Jessup M
        • Linde C
        • Nihoyannopoulos P
        • Parissis JT
        • Pieske B
        • Riley JP
        • Rosano GMC
        • Ruilope LM
        • Ruschitzka F
        • Rutten FH
        • van der Meer P
        • ESC Scientific Document Group
        2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
        Eur Heart J. 2016; 37: 2129-2200
        • Godino C
        • Scotti A
        • Taramasso M
        • Adamo M
        • Russo M
        • Chiarito M
        • Melillo F
        • Beneduce A
        • Pivato CA
        • Arrigoni L
        • Toscano E
        • Salerno A
        • Cappelletti A
        • Magni V
        • Stella S
        • Fragasso G
        • Montorfano M
        • Agricola E
        • Ettori F
        • Margonato A
        • Maisano F
        • Colombo A.
        Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy.
        Int J Cardiol. 2018; 269: 33-39
        • Godino C
        • Sisinni A
        • Pivato CA
        • Adamo M
        • Taramasso M
        • Parlati A
        • Italia L
        • Voci D
        • Scotti A
        • Munafò A
        • Buzzatti N
        • Denti P
        • Ancona F
        • Fiore G
        • Sala A
        • Vergara P
        • Bodega F
        • Ruffo MM
        • Curello S
        • Castiglioni A
        • De Bonis M
        • Alfieri O
        • Agricola E
        • Maisano F
        • Metra M
        • Colombo A
        • Margonato A
        MiZüBr registry. Prognostic Value of Pre-operative Atrial Fibrillation in patients with secondary mitral regurgitation undergoing mitraclip implantation.
        Am J Cardiol. 2021; 143: 51-59
        • Lancellotti P
        • Tribouilloy C
        • Hagendorff A
        • Popescu BA
        • Edvardsen T
        • Pierard LA
        • Badano L
        • Zamorano JL
        Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.
        Eur Heart J Cardiovasc Imaging. 2013; 14: 611-644
        • Lang RM
        • Badano LP
        • Mor-Avi V
        • Afilalo J
        • Armstrong A
        • Ernande L
        • Flachskampf FA
        • Foster E
        • Goldstein SA
        • Kuznetsova T
        • Lancellotti P
        • Muraru D
        • Picard MH
        • Rietzschel ER
        • Rudski L
        • Spencer KT
        • Tsang W
        • Voigt JU.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        J Am Soc Echocardiogr. 2015; 28 (e14): 1-39
        • Meluzín J
        • Spinarová L
        • Bakala J
        • Toman J
        • Krejcí J
        • Hude P
        • Kára T
        • Soucek M.
        Pulsed Doppler tissue imaging of the velocity of tricuspid annular systolic motion; a new, rapid, and non-invasive method of evaluating right ventricular systolic function.
        Eur Heart J. 2001; 22: 340-348
        • Levey AS
        • Stevens LA
        • Schmid CH
        • Zhang YL
        • Castro 3rd, AF
        • Feldman HI
        • Kusek JW
        • Eggers P
        • Van Lente F
        • Greene T
        • Coresh J
        • CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
        A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150: 604-612
        • Khwaja A.
        KDIGO clinical practice guidelines for acute kidney injury.
        Nephron Clin Pract. 2012; 120: c179-c184
        • Hindricks G
        • Potpara T
        • Dagres N
        • Arbelo E
        • Bax JJ
        • Blomström-Lundqvist C
        • Boriani G
        • Castella M
        • Dan GA
        • Dilaveris PE
        • Fauchier L
        • Filippatos G
        • Kalman JM
        • La Meir M
        • Lane DA
        • Lebeau JP
        • Lettino M
        • Lip GYH
        • Pinto FJ
        • Thomas GN
        • Valgimigli M
        • Van Gelder IC
        • Van Putte BP
        • Watkins CL
        • ESC Scientific Document Group
        2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2021; 42: 373-498
        • Stone GW
        • Vahanian AS
        • Adams DH
        • Abraham WT
        • Borer JS
        • Bax JJ
        • Schofer J
        • Cutlip DE
        • Krucoff MW
        • Blackstone EH
        • Généreux P
        • Mack MJ
        • Siegel RJ
        • Grayburn PA
        • Enriquez-Sarano M
        • Lancellotti P
        • Filippatos G
        • Kappetein AP
        • Mitral Valve Academic Research Consortium (MVARC)
        Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 1: Clinical trial design principles: A consensus document from the Mitral Valve Academic Research Consortium.
        J Am Coll Cardiol. 2015; 66: 278-307
        • Bhatia RS
        • Tu JV
        • Lee DS
        • Austin PC
        • Fang J
        • Haouzi A
        • Gong Y
        • Liu PP.
        Outcome of heart failure with preserved ejection fraction in a population-based study.
        N Engl J Med. 2006; 355: 260-269
        • Nohria A
        • Hasselblad V
        • Stebbins A
        • Pauly DF
        • Fonarow GC
        • Shah M
        • Yancy CW
        • Califf RM
        • Stevenson LW
        • Hill JA.
        Cardiorenal interactions: insights from the ESCAPE trial.
        J Am Coll Cardiol. 2008; 51: 1268-1274
        • Damman K
        • van Deursen VM
        • Navis G
        • Voors AA
        • van Veldhuisen DJ
        • Hillege HL.
        Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease.
        J Am Coll Cardiol. 2009; 53: 582-588
        • Alessandrini H
        • Kreidel F
        • Schlüter M
        • Frerker C
        • Schmidt T
        • Thielsen T
        • Schäfer U
        • Kuck KH.
        Prognostic implication of post-MitraClip vena contracta area in heart failure patients with functional mitral regurgitation.
        EuroIntervention. 2017; 12: 1946-1953
        • GBD Chronic Kidney Disease Collaboration
        Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2020; 395: 709-733
        • Capodanno D
        • Adamo M
        • Barbanti M
        • Giannini C
        • Laudisa ML
        • Cannata S
        • Curello S
        • Immè S
        • Maffeo D
        • Bedogni F
        • Petronio AS
        • Ettori F
        • Tamburino C
        • Grasso C
        GRASP-IT Investigators. Predictors of clinical outcomes after edge-to-edge percutaneous mitral valve repair.
        Am Heart J. 2015; 170: 187-195
        • Guazzi M
        • Gatto P
        • Giusti G
        • Pizzamiglio F
        • Previtali I
        • Vignati C
        • Arena R.
        Pathophysiology of cardiorenal syndrome in decompensated heart failure: role of lung-right heart-kidney interaction.
        Int J Cardiol. 2013; 169: 379-384
        • Spieker M
        • Hellhammer K
        • Katsianos S
        • Wiora J
        • Zeus T
        • Horn P
        • Kelm M
        • Westenfeld R.
        Effect of acute kidney injury after percutaneous mitral valve repair on outcome.
        Am J Cardiol. 2018; 122: 316-322