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Residual Mitral Regurgitation Interacts With Transmitral Mean Pressure Gradient to Modify the Association With
Neal M Duggal1, Milo Engoren1, Paul Sorajja2
1Department of Anesthesiology, University of Michigan, Ann Arbor (N.M.D., M.E.).
Circulation. Cardiovascular Interventions
|January 28, 2025
Summary
Residual mitral regurgitation (rMR) and transmitral mean pressure gradient (TMPG) after transcatheter edge-to-edge repair are linked to 1-year mortality. Higher rMR amplifies the impact of TMPG on mortality risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- The association between transmitral mean pressure gradient (TMPG) and 1-year mortality post-mitral transcatheter edge-to-edge repair (MTEER) is debated.
- Mitral transcatheter edge-to-edge repair (MTEER) using the MitraClip system is a key treatment for severe secondary mitral regurgitation (MR).
Purpose of the Study:
- To assess the relationship between intraoperatively measured residual mitral regurgitation (rMR) and TMPG with 1-year mortality in patients undergoing MTEER.
- To inform decisions regarding the need for additional devices based on post-procedural rMR and TMPG.
Main Methods:
- Analysis of registry data from 570 patients with severe secondary MR who underwent MTEER.
- Utilized generalized estimating equations and nonlinear fractional polynomial transformations for rMR and TMPG analysis.
- Adjusted for confounders to estimate the association with 1-year mortality.
Main Results:
- Postprocedural MR improved significantly, with 95% of patients having MR ≤2+.
- 1-year mortality was 20% in the study cohort.
- Both rMR (OR, 2.10) and TMPG were independently associated with 1-year mortality, with TMPG showing a dose-dependent effect.
Conclusions:
- Both residual mitral regurgitation (rMR) and transmitral mean pressure gradient (TMPG) are nonlinearly associated with 1-year mortality after MTEER.
- The impact of TMPG on mortality risk is amplified at higher levels of rMR.
- Small changes in TMPG significantly increase mortality risk when rMR is high.
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