Outcome of transcatheter edge-to-edge mitral valve repair in patients with diabetes mellitus: Results from a real-world cohort

Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair

Aim

Diabetes mellitus (DM) represents a notable risk factor within surgical and interventional procedures. Data on its influence on survival after Transcatheter Edge-to-Edge Repair (TEER) of Mitral valve Regurgitation (MR) are sparse.

Methods

In a retrospective monocentric assessment after successful treatment of MR using TEER from 06/2010 to 03/2018 patients were stratified for DM. Mortality was analyzed during follow-up using Cox regression analyses.

Results

Of 627 patients (47.0 % females, 88.2 % aged ≥ 70 years, median follow-up 486 days) consecutively included, subjects with DM (N = 174, 27.8 %) had a higher prevalence of comorbidities like obesity (27.3 % vs. 9.2 %, p < 0.001), arterial hypertension (91.4 % vs. 83.7 %, p = 0.013), renal insufficiency (63.8 % vs. 43.9 %, p < 0.001), coronary artery disease (77.0 % vs. 59.8 %, p < 0.001) and peripheral artery disease (14.4 % vs. 8.4 %, p = 0.026). Patients with DM presented with higher median logistic Euroscore I (29.4 % [20.0/43.0] vs. 25.0 % [16.7/36.6], p = 0.001) and more severely reduced systolic function (LVEF 35 % [30/50] vs. 45 % [30/55], p < 0.001). No difference in short- and long-term survival was detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6 %, p = 0.771; at 30-days 5.0 vs. 6.0 %, p = 0.842, 1-year 28.7 vs. 25.0 %, p = 0.419, 3-years 49.2 vs. 44.1 %, p = 0.554, 5-years 69.0 vs. 68.3 %, p = 0.497). The presence of DM was not attributed as an individual risk factor for elevated mortality (HR 1-year 1.17 [95 % CI 0.80-1.71], p = 0.419; HR long-term 1.13 [95 %CI 0.86-1.49], p = 0.373).

Conclusion

Although linked to a more vulnerable clinical profile and despite being factored in common risk factor models, DM was not associated with an elevated short- and long-term mortality after TEER of MR.

Prevalence and impact of diabetes in patients with valvular heart disease

This study aimed to investigate the prevalence of diabetes in valvular heart disease (VHD), as well as the relationship of diabetes with severity of valvular lesions and clinical outcome. A total of 11,862 patients with significant (≥moderate) VHD from the China Valvular Heart Disease study were included in the analysis. The primary outcome was the composite of all-cause death, hospitalization for heart failure, and myocardial infarction during two-year follow-up. The prevalence of diabetes was 14.5% (1,721/11,862) in VHD. After adjusting for patients' demographics, diabetes was associated with a significantly lower risk of severe valvular lesion in aortic regurgitation and mitral regurgitation (MR). In multivariable analysis, diabetes was identified as an independent predictor of two-year outcome in patients with MR (hazard ratio: 1.345, 95% confidence interval: 1.069-1.692, p = 0.011). More efforts should be made to enhance our understanding and improve outcomes of concomitant VHD and diabetes.

Diabetes Mellitus in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair-A Decade Experience in 1000+ Patients

BACKGROUND

Diabetes mellitus worsens outcomes in patients suffering from heart disease undergoing cardiac procedures.

OBJECTIVES

To investigate the impact of diabetes in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER).

METHODS

1118 patients treated with M-TEER for functional (FMR) and degenerative (DMR) mitral regurgitation (MR) between 2010 and 2021 were analyzed using the combined endpoint of death/rehospitalization for heart failure (HFH).

RESULTS

Among diabetics (N = 306; 27.4%), comorbidities such as coronary artery disease (75.2% vs. 62.7%; p < 0.001) and progressed (stage III/IV) chronic kidney disease (79.5% vs. 72.6%; p = 0.018) were more frequent. The rate of FMR was higher in diabetics (71.9% vs. 64.5%; p < 0.001). The combined endpoint occurred more frequently in diabetics (40.2% vs. 35.6%; log-rank = 0.035). While no difference was observed in FMR patients (36.8% vs. 37.6%; log-rank p = 0.710), rates of the combined endpoint differed significantly between diabetics and non-diabetics in DMR patients (48.8% vs. 31.9%; log-rank p = 0.001) only. However, diabetes did neither predict the combined endpoint in the overall (OR: 0.97; 95% CI 0.65-1.45; p = 0.890) nor in the DMR cohort (OR: 0.73; 95% CI 0.35-1.51; p = 0.389). Among diabetics treated with M-TEER, troponin (OR: 2.32; 95% CI 1.3-3.7; p = 0.002) and estimated glomerular filtration rate (OR: 0.52; 95% CI 0.3-0.88; p = 0.018) independently predicted the combined endpoint.

CONCLUSIONS

Diabetes is associated with adverse outcomes after M-TEER, particularly in DMR patients. However, diabetes does not predict the combined endpoint. In diabetics undergoing M-TEER, biochemical markers associated with organ function and damage independently predict the combined endpoint of death and rehospitalization.