Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions (TRAMI) registry.
Heart failure hospitalization
Left atrial diameter
MitraClip
Mortality
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
18
12
2019
revised:
13
03
2020
accepted:
19
03
2020
pubmed:
5
4
2020
medline:
20
5
2021
entrez:
5
4
2020
Statut:
ppublish
Résumé
Left atrial (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair, LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation. Data from the multicentre German TRAnscatheter Mitral valve Interventions registry (TRAMI) were used to analyse the association of baseline LA diameter by tertiles with efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with MitraClip. In 520 of 843 patients prospectively enrolled in TRAMI, baseline LA diameter were reported [median (interquartile range) LA diameter in tertiles: 44 (40-46) mm, 51 (48-53) mm and 60 (55-66) mm]. Larger LA diameters were significantly associated with secondary aetiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all P < 0.05). Technical success was not different across tertiles (96%, 95.4% and 98.4%, respectively; P = 0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke: 1.8%, 1.2% and 4.4%, respectively; P = 0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7%, respectively; P < 0.01), as did hospitalization in survivors (60%, 67.6% and 78.9%, respectively; P < 0.05). The association between LA diameter and outcome remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter. Left atrial enlargement is a strong and independent predictor of adverse long-term outcome after transcatheter mitral valve repair. Further study is warranted to examine whether timely intervention may have the potential to modify outcome.
Sections du résumé
BACKGROUND
Left atrial (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair, LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.
METHODS AND RESULTS
Data from the multicentre German TRAnscatheter Mitral valve Interventions registry (TRAMI) were used to analyse the association of baseline LA diameter by tertiles with efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with MitraClip. In 520 of 843 patients prospectively enrolled in TRAMI, baseline LA diameter were reported [median (interquartile range) LA diameter in tertiles: 44 (40-46) mm, 51 (48-53) mm and 60 (55-66) mm]. Larger LA diameters were significantly associated with secondary aetiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all P < 0.05). Technical success was not different across tertiles (96%, 95.4% and 98.4%, respectively; P = 0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke: 1.8%, 1.2% and 4.4%, respectively; P = 0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7%, respectively; P < 0.01), as did hospitalization in survivors (60%, 67.6% and 78.9%, respectively; P < 0.05). The association between LA diameter and outcome remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.
CONCLUSION
Left atrial enlargement is a strong and independent predictor of adverse long-term outcome after transcatheter mitral valve repair. Further study is warranted to examine whether timely intervention may have the potential to modify outcome.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1202-1210Subventions
Organisme : Abbott
Pays : International
Organisme : Deutsche Herzstiftung
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
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, Lefevre T, Piot C, Rouleau F, Carrie 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.
Dziadzko V, Dziadzko M, Medina-Inojosa JR, Benfari G, Michelena HI, Crestanello JA, Maalouf J, Thapa P, Enriquez-Sarano M. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J 2019;40:2194-2202.
Essayagh B, Antoine C, Benfari G, Messika-Zeitoun D, Michelena H, Le Tourneau T, Mankad S, Tribouilloy CM, Thapa P, Enriquez-Sarano M. Prognostic implications of left atrial enlargement in degenerative mitral regurgitation. J Am Coll Cardiol 2019;74:858-870.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-2791.
Di Tullio MR, Qian M, Thompson JLP, Labovitz AJ, Mann DL, Sacco RL, Pullicino PM, Freudenberger RS, Teerlink JR, Graham S, Lip GY, Levin B, Mohr JP, Buchsbaum R, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Homma S; WARCEF Investigators. Left atrial volume and cardiovascular outcomes in systolic heart failure: effect of antithrombotic treatment. ESC Heart Fail 2018;5:800-808.
Donal E, Lund LH, Oger E, Bosseau C, Reynaud A, Hage C, Drouet E, Daubert JC, Linde C; KaRen Investigators. Importance of combined left atrial size and estimated pulmonary pressure for clinical outcome in patients presenting with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2017;18:629-635.
Rossi A, Temporelli PL, Quintana M, Dini FL, Ghio S, Hillis GS, Klein AL, Marsan NA, Prior DL, Yu CM, Poppe KK, Doughty RN, Whalley GA; MeRGE Heart Failure Collaborators. Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur J Heart Fail 2009;11:929-936.
Deferm S, Bertrand PB, Verbrugge FH, Verhaert D, Rega F, Thomas JD, Vandervoort PM. Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol 2019;73:2465-2476.
Kagiyama N, Mondillo S, Yoshida K, Mandoli GE, Cameli M. Subtypes of atrial functional mitral regurgitation: imaging insights into their mechanisms and therapeutic implications. JACC Cardiovasc Imaging 2020;13:820-835.
Kim J, Alakbarli J, Palumbo MC, Xie LX, Rong LQ, Tehrani NH, Brouwer LR, Devereux RB, Wong SC, Bergman GW, Khalique OK, Levine RA, Ratcliffe MB, Weinsaft JW. Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: integrated assessment by two- and three-dimensional echocardiography. Catheter Cardiovasc Interv 2019;93:1152-1160.
Baldus S, Schillinger W, Franzen O, Bekeredjian R, Sievert H, Schofer J, Kuck KH, Konorza T, Möllmann H, Hehrlein C, Ouarrak T, Senges J, Meinertz T; German Transcatheter Mitral Valve Interventions (TRAMI) Investigators. MitraClip therapy in daily clinical practice: initial results from the German Transcatheter Mitral Valve Interventions (TRAMI) registry. Eur J Heart Fail 2012;14:1050-1055.
Rudolph V, Huntgeburth M, von Bardeleben RS, Boekstegers P, Lubos E, Schillinger W, Ouarrak T, Eggebrecht H, Butter C, Plicht B, May A, Franzen O, Schofer J, Senges J, Baldus S. Clinical outcome of critically ill, not fully recompensated, patients undergoing MitraClip therapy. Eur J Heart Fail 2014;16:1223-1229.
Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451-2496.
Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS, Smalling RW, Siegel R, Rose GA, Engeron E, Loghin C, Trento A, Skipper ER, Fudge T, Letsou GV, Massaro JM, Mauri L; EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 2011;364:1395-1406.
Kalbacher D, Schäfer UV, Bardeleben RS, Eggebrecht H, Sievert H, Nickenig G, Butter C, May AE, Bekeredjian R, Ouarrak T, Kuck K-H, 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.
Lubos E, Schlüter M, Vettorazzi E, Goldmann B, Lubs D, Schirmer J, Treede H, Reichenspurner H, Blankenberg S, Baldus S, Rudolph V. MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. JACC Cardiovasc Interv 2014;7:394-402.
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.
Grayburn PA, Foster E, Sangli C, Weissman NJ, Massaro J, Glower DG, Feldman T, Mauri L. Relationship between the magnitude of reduction in mitral regurgitation severity and left ventricular and left atrial reverse remodeling after MitraClip therapy. Circulation 2013;128:1667-1674.
Rosca M, Lancellotti P, Popescu BA, Piérard LA. Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart 2011;97:1982-1989.
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. Eur Heart J 2015;16:233-271.
Kedia G, Habibzadeh MR, Kudithipudi V, Molls F, Sorrell VL. Using traditional measurements of the left atrial diameter to predict the left atrial volume index. Echocardiography 2008;25:36-39.
Canciello G, de Simone G, Izzo R, Giamundo A, Pacelli F, Mancusi C, Galderisi M, Trimarco B, Losi MA. Validation of left atrial volume estimation by left atrial diameter from the parasternal long-axis view. J Am Soc Echocardiogr 2017;30:262-269.