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Meta-Analysis of Relation Between Left Ventricular Dysfunction and Outcomes After Transcatheter Mitral Edge-to-Edge

Andrea Scotti1, Mauro Massussi2, Azeem Latib1

  • 1Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

The American Journal of Cardiology
|May 13, 2022
PubMed

Insights

Transcatheter edge-to-edge repair (TEER) may increase death or heart failure hospitalization risk in severe left ventricular (LV) dysfunction. However, clinical outcomes like NYHA class were similar regardless of LV function.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • Conflicting evidence exists on left ventricular (LV) function's impact on outcomes following transcatheter edge-to-edge repair (TEER).
  • Severe LV dysfunction is a critical factor in heart failure (HF) management.

Purpose of the Study:

  • To comprehensively assess the relationship between severe LV dysfunction and outcomes after TEER for secondary mitral regurgitation.
  • To evaluate the influence of LV ejection fraction on mortality, HF hospitalizations, and functional status post-TEER.

Main Methods:

  • A systematic search of multiple databases (PubMed, EMBASE, Scopus, Web of Science, CENTRAL) identified 6 studies with 1,957 patients.
  • Meta-analysis using random-effects models estimated odds ratios (ORs) for primary end points: all-cause death/HF hospitalization and NYHA class III/IV.
  • Sensitivity analyses were performed to account for baseline characteristics and study design.

Main Results:

  • Severe LV dysfunction was linked to a higher risk of death or HF hospitalization (OR 1.71, 95% CI 1.14 to 2.57).
  • Comparable rates of NYHA class III/IV and secondary outcomes were observed irrespective of baseline LV function.
  • Subgroup analysis of RCTs showed no significant difference in the primary composite end point between patients with LV ejection fraction <30% and ≥30%.

Conclusions:

  • TEER in patients with severe LV dysfunction may be associated with increased mortality or HF hospitalization rates.
  • However, functional status (NYHA class) and other clinical outcomes were not significantly impacted by LV function.
  • Randomized controlled trials suggest no difference in primary outcomes based on LV function, highlighting the need for further investigation.

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