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Prognostic Impact of Modified J-MACS Score in Patients With Systolic Heart Failure Receiving Transcatheter

Yohei Ueno¹, Teruhiko Imamura¹, Shuhei Tanaka¹

¹Second Department of Internal Medicine University of Toyama Toyama Japan.

Journal of the American Heart Association

|September 30, 2025

Abstract

Background:

Given the relatively high morbidity and death associated with transcatheter edge-to-edge repair for secondary mitral regurgitation, the development of optimal risk stratification models is imperative. The J-MACS (Japanese Registry for Mechanically Assisted Circulatory Support) score is a recently developed tool designed to stratify risk in patients with advanced heart failure undergoing durable left ventricular assist device implantation.

Methods:

Data were obtained from the OCEAN-Mitral (Optimized Catheter Valvular Intervention-Mitral) registry on patients with secondary mitral regurgitation and left ventricular ejection fraction <50% who underwent transcatheter edge-to-edge repair. A newly innovated modified J-MACS score, incorporating age, history of cardiac surgery, serum creatinine levels, and postprocedural moderate or greater tricuspid regurgitation, was calculated. Its prognostic significance regarding the primary outcome, comprising all-cause death and heart failure-related hospitalizations, was assessed.

Results:

A total of 2006 patients (median age, 77 years; 63% men) were included in the study. The median modified J-MACS score was 13.7 (interquartile range, 12.0-16.2). Based on statistically calculated optimal cutoff values of 11.4 and 14.0, patients were stratified into 3 risk categories: low, moderate, and high. The 2-year cumulative incidence of the primary outcome differed significantly among these groups (26%, 37%, and 51%, respectively; P<0.001). Risk group classification remained independently associated with the primary outcome, with an adjusted hazard ratio of 1.42 (95% CI, 1.13-1.71; P<0.001) for the intermediate risk versus low risk and 2.27 (95% CI, 1.67-2.96; P<0.001) for the high risk versus low risk.

Conclusions:

The modified J-MACS score demonstrated an independent association with all-cause death and heart failure-related hospitalization following transcatheter edge-to-edge repair in patients with significant mitral regurgitation and systolic heart failure.

Registration:

URL: https://upload.umin.ac.jp; Unique Identifier: UMIN000023653.

Keywords:

MitraClip heart failure hemodynamics valvular disease

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