1
|
Deferm S, Bertrand PB, Dhont S, von Bardeleben RS, Vandervoort PM. Arrythmia-Mediated Valvular Heart Disease. Heart Fail Clin 2023; 19:357-377. [PMID: 37230650 DOI: 10.1016/j.hfc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aging population is rising at record pace worldwide. Along with it, a steep increase in the prevalence of atrial fibrillation and heart failure with preserved ejection fraction is to be expected. Similarly, both atrial functional mitral and tricuspid regurgitation (AFMR and AFTR) are increasingly observed in daily clinical practice. This article summarizes all current evidence regarding the epidemiology, prognosis, pathophysiology, and therapeutic options. Specific attention is addressed to discern AFMR and AFTR from their ventricular counterparts, given their different pathophysiology and therapeutic needs.
Collapse
Affiliation(s)
- Sébastien Deferm
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/S_Deferm
| | - Philippe B Bertrand
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/Ph_Bertrand
| | - Sebastiaan Dhont
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium. https://twitter.com/S_Dhont
| | - Ralph S von Bardeleben
- Department of Cardiology, Mainz University Hospital, Langenbeckstraße 1, Mainz, Germany. https://twitter.com/vonbardelebenRS
| | - Pieter M Vandervoort
- Hasselt University, Agoralaan Building D, 3590 Diepenbeek, Belgium; Department of Cardiology, Hospital Oost-Limburg Genk, Schiepse Bos 6, 3600 Genk, Belgium.
| |
Collapse
|
2
|
Keller K, Geyer M, Hobohm L, Tamm AR, Kreidel F, Ruf TF, Hell M, Schmitt VH, Bachmann K, Born S, Schulz E, Münzel T, von Bardeleben RS. Survival benefit of overweight patients undergoing MitraClip® procedure in comparison to normal-weight patients. Clin Cardiol 2022; 45:1236-1245. [PMID: 36070481 DOI: 10.1002/clc.23897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The number of MitraClip® implantations increased significantly in recent years. Data regarding the impact of weight class on survival are sparse. HYPOTHESIS We hypothesized that weight class influences survival of patients treated with MitraClip® implantation. METHODS We investigated in-hospital, 1-year, 3-year, and long-term survival of patients successfully treated with isolated MitraClip® implantation for mitral valve regurgitation (MR) (June 2010-March 2018). Patients were categorized by weight classes, and the impact of weight classes on survival was analyzed. RESULTS Of 617 patients (aged 79.2 years; 47.3% females) treated with MitraClip® implantation (June 2010-March 2018), 12 patients were underweight (2.2%), 220 normal weight (40.1%), 237 overweight (43.2%), and 64 obesity class I (11.7%), 12 class II (2.2%), and 4 class III (0.7%). Preprocedural Logistic EuroScore (21.1 points [IQR 14.0-37.1]; 26.0 [18.5-38.5]; 26.0 [18.4-39.9]; 24.8 [16.8-33.8]; 33.0 [25.9-49.2]; 31.6 [13.1-47.6]; p = .291) was comparable between groups. Weight class had no impact on in-hospital death (0.0%; 4.1%; 1.5%; 0.0%; 7.7%; 0.0%; p = .189), 1-year survival (75.0%; 72.0%; 76.9%; 75.0%; 75.0%; 33.3%; p = .542), and 3-year survival (40.0%; 36.8%; 38.2%; 48.6%; 20.0%; 33.3%; p = .661). Compared to normal weight, underweight (hazard ratio [HR]: 1.35 [95% confidence interval [CI]: 0.65-2.79], p = .419), obesity-class I (HR: 0.93 [95% CI: 0.65-1.34], p = .705), class II (HR: 0.39 [95% CI: 0.12-1.24], p = .112), and class III (HR: 1.28 [95% CI: 0.32-5.21], p = .726) did not affect long-term survival. In contrast, overweight was associated with better survival (HR: 1.32 [95% CI: 1.04-1.68], p = .023). CONCLUSION Overweight affected the long-term survival of patients undergoing MitraClip® implantation beneficially compared to normal weight.
Collapse
Affiliation(s)
- Karsten Keller
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Medical Clinic VII: Department of Sports Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Geyer
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander R Tamm
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Felix Kreidel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tobias F Ruf
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michaela Hell
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Volker H Schmitt
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Kevin Bachmann
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sonja Born
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Eberhard Schulz
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| | - Ralph S von Bardeleben
- Department of Cardiology, Cardiology I, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein Main, Mainz, Germany
| |
Collapse
|
3
|
Witte KK, Kaye DM, Lipiecki J, Siminiak T, Goldberg SL, von Bardeleben RS, Sievert H, Levy WC, Starling RC. Treating symptoms and reversing remodelling: clinical and echocardiographic 1-year outcomes with percutaneous mitral annuloplasty for mild to moderate secondary mitral regurgitation. Eur J Heart Fail 2021; 23:1971-1978. [PMID: 34288287 DOI: 10.1002/ejhf.2310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS To determine the effects of percutaneous mitral annuloplasty on symptoms, walk distance and left ventricular (LV) structure and function in patients with mild or moderate secondary mitral regurgitation (SMR). METHODS AND RESULTS This was a pooled analysis of patients (n = 68) who, despite guideline-directed medical therapy had symptomatic heart failure (HF) with mild (n = 25) or moderate (n = 43) SMR treated with percutaneous mitral annuloplasty as part of the TITAN, TITAN II, or REDUCE-FMR trials. Primary outcomes were changes in symptoms, 6-min walk distance, and quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) after 1 year. Secondary analyses included changes in LV structure and function. At 1 year, New York Heart Association class status was maintained (48%) or improved (46%) in most patients, mean KCCQ scores increased from baseline by 10 units [95% confidence interval (CI) 3 to17; P < 0.01] and mean 6-min walk test distance increased by 34 m (95% CI 12 to 57; P < 0.01). SMR grade improved in 25% of patients and was maintained in 58% of patients with changes in mean regurgitant volume of -7 mL (95% CI -11 to -3; P < 0.001), vena contracta -0.11 cm (95% CI -0.20 to -0.02; P < 0.05), and effective regurgitant orifice area -0.03 cm2 (95% CI -0.06 to -0.01; P < 0.05). There were non-significant improvements in LV ejection fraction and volumes. Survival over 1 year was 89% with no difference between mild (96%) and moderate (86%) SMR (log-rank P = 0.22). Progression-free survival was 70% (82% in mild vs. 63% in moderate SMR; P = 0.16). Freedom from HF hospitalization was 73% (87% in mild SMR vs. 66% in moderate SMR; P = 0.07). CONCLUSION Among patients with symptomatic HF and mild or moderate SMR on guideline-directed medical therapy, percutaneous mitral annuloplasty was associated with improvements in symptoms, SMR, a stabilization of LV structure and function, and high survival rates.
Collapse
Affiliation(s)
- Klaus K Witte
- Department of Internal Medicine I, University Clinic, RWTH Aachen University, Aachen, Germany
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | | | - Tomasz Siminiak
- HCP Medical Center, Poznan University of Medical Sciences, Poznan, Poland
| | - Steven L Goldberg
- Tyler Heart Institute at Community Hospital of the Monterey Peninsula, Monterey, CA, USA
- Cardiac Dimensions, Kirkland, WA, USA
| | | | - Horst Sievert
- CardioVascular Center Sankt Katherinen, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Wayne C Levy
- Advanced Heart Failure, Division of Cardiology, University of Washington Heart Institute, Seattle, WA, USA
| | - Randall C Starling
- Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
4
|
Stocker TJ, Hertell H, Orban M, Braun D, Rommel KP, Ruf T, Ong G, Nabauer M, Deseive S, Fam N, von Bardeleben RS, Thiele H, Massberg S, Lurz P, Hausleiter J. Cardiopulmonary Hemodynamic Profile Predicts Mortality After Transcatheter Tricuspid Valve Repair in Chronic Heart Failure. JACC Cardiovasc Interv 2020; 14:29-38. [PMID: 33309317 DOI: 10.1016/j.jcin.2020.09.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/16/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to assess hemodynamic changes in response to transcatheter tricuspid valve edge-to-edge repair (TTVR) and to identify hemodynamic predictors associated with mortality. BACKGROUND Severe tricuspid regurgitation (TR) is associated with high mortality. TTVR effectively alleviates heart failure symptoms, but comprehensive hemodynamic characterization of patients undergoing TTVR is currently lacking. METHODS This international, multicenter study included 236 patients undergoing TTVR. Data from clinical assessment, echocardiography, intraprocedural right heart catheterization, and noninvasive cardiac output measurement were analyzed. Hemodynamic predictors for mortality were identified using linear Cox regression analysis and were used for stratification of patients with subsequent analysis of survival time. RESULTS Patients (median age 78 years, 53% women) were symptomatic (89% in New York Heart Association functional class III or IV) because of severe TR (grade ≥3+ in 100%). TTVR significantly reduced TR at discharge (grade ≥3+ in 16%; p < 0.001), with a corresponding 19% reduction of the right atrial v wave (21 mm Hg vs. 16 mm Hg; p < 0.001) and an improvement in cardiac output (from 3.5 to 4.0 l/min; p < 0.01). Invasive mean pulmonary artery pressure, transpulmonary gradient, pulmonary vascular resistance, and right ventricular stroke work were significant predictors of 1-year mortality (p < 0.05 for all). Hemodynamic stratification by mean pulmonary artery pressure and transpulmonary gradient best predicted 1-year survival (p < 0.001). Although patients with pre-capillary dominant pulmonary hypertension showed an unfavorable prognosis (1-year survival 38%), patients without or with post-capillary pulmonary hypertension had favorable outcome (1-year survival 92% or 78%, respectively). CONCLUSIONS Invasive assessment of cardiopulmonary hemodynamic status predicts survival after TTVR. Invasive hemodynamic characterization may help identify patients profiting most from TTVR.
Collapse
Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Helene Hertell
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg University, Mainz, Germany
| | - Geraldine Ong
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Nabauer
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Holger Thiele
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Lurz
- Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Ludwig-Maximilians-Universität, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| |
Collapse
|
5
|
Hobohm L, von Bardeleben RS, Ostad MA, Wenzel P, Münzel T, Gori T, Keller K. 5-Year Experience of In-Hospital Outcomes After Percutaneous Left Atrial Appendage Closure in Germany. JACC Cardiovasc Interv 2020; 12:1044-1052. [PMID: 31171280 DOI: 10.1016/j.jcin.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate 5-year in-hospital trends and safety outcomes of left atrial appendage (LAA) closure in the German nationwide inpatient sample. BACKGROUND The safety and efficacy of percutaneous LAA closure have been demonstrated in randomized trials and prospective cohort studies, but results from large samples are missing. METHODS Data on patient characteristics and in-hospital safety outcomes for all percutaneous LAA closures performed in Germany between 2011 and 2015 were analyzed. Overall, 15,895 inpatients were included. RESULTS The annual number of LAA occlusions increased from 1,347 in 2011 to 4,932 in 2015 (β = 1.00; 95% confidence interval [CI]: 0.95 to 1.01; p < 0.001), with a nonsignificant uptrend of in-hospital mortality (from 0.5% in 2011 to 0.9% in 2015; β = 0.01; 95% CI: -0.09 to 0.32; p = 0.271). Patient characteristics shifted toward older age and higher prevalence of comorbidities such as heart failure, chronic obstructive pulmonary disease, and chronic renal insufficiency over time. Important independent predictors of in-hospital mortality were cancer (odds ratio [OR]: 2.49; 95% CI: 1.00 to 6.12; p = 0.050), heart failure (OR: 2.42; 95% CI: 1.72 to 3.41; p < 0.001), stroke (OR: 5.39; 95% CI: 2.76 to 10.53; p < 0.001), acute renal failure (OR: 13.28; 95% CI: 9.08 to 19.42; p < 0.001), pericardial effusion (OR: 5.65; 95% CI: 3.76 to 8.48; p < 0.001), and shock (OR: 45.11; 95% CI: 31.01 to 65.58; p < 0.001). CONCLUSIONS The use of percutaneous LAA closure increased 3.6-fold from 2011 to 2015, with a nonsignificant uptrend of in-hospital mortality rate in this real-world setting. Important predictors of in-hospital death were acute renal failure, pericardial effusion, and ischemic stroke during hospitalization.
Collapse
Affiliation(s)
- Lukas Hobohm
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Ralph S von Bardeleben
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mir A Ostad
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Philip Wenzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Mainz, Germany
| | - Thomas Münzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Mainz, Germany
| | - Tommaso Gori
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine Main, Mainz, Germany
| | - Karsten Keller
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| |
Collapse
|
6
|
Jabs A, von Bardeleben RS, Boekstegers P, Puls M, Lubos E, Bekeredjian R, Ouarrak T, Plicht B, Eggebrecht H, Nickenig G, Butter C, Hoffmann R, Senges J, Hink U. Effects of atrial fibrillation and heart rate on percutaneous mitral valve repair with MitraClip: results from the TRAnscatheter Mitral valve Interventions (TRAMI) registry. EUROINTERVENTION 2017; 12:1697-1705. [PMID: 28216472 DOI: 10.4244/eij-d-16-00115] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS In patients undergoing percutaneous edge-to-edge mitral valve repair for mitral valve regurgitation (MR), our aim was to evaluate acute and follow-up differences with pre-existing sinus rhythm (SR) or atrial fibrillation (AF), as well as comparisons stratified by baseline heart rate. METHODS AND RESULTS Seven hundred and sixty patients who underwent a MitraClip procedure were prospectively enrolled in the TRAnscatheter Mitral valve Interventions (TRAMI) registry, and stratified according to baseline heart rhythm and heart rate with a cut-off value of 70 beats per minute. Technical success, procedural characteristics and MR reduction were similar throughout the subgroups. Overall, in-hospital adverse event rates were low in this high-risk patient collective. At 12 months, survival was higher in SR (83.5%) than AF patients (74.9%, p<0.05), while the cumulative major adverse cardio-cerebrovascular event rate did not differ, and a sustained improvement of NYHA functional class occurred in all subgroups. CONCLUSIONS These registry data, comprising the largest number of unselected "real-world" MitraClip patients, suggest that the intervention can be performed safely and effectively, and reduces MR in the majority of patients irrespective of baseline rhythm or heart rate. While 12-month survival was higher for patients with SR, overall MACCE and clinical improvement did not differ between the subgroups.
Collapse
Affiliation(s)
- Alexander Jabs
- Zentrum für Kardiologie, Kardiologie 1, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Geis NA, Puls M, Lubos E, Zuern CS, Franke J, Schueler R, von Bardeleben RS, Boekstegers P, Ouarrak T, Zahn R, Ince H, Senges J, Katus HA, Bekeredjian R. Safety and efficacy of MitraClip™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry. Eur J Heart Fail 2017; 20:598-608. [PMID: 28834079 DOI: 10.1002/ejhf.910] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/01/2017] [Accepted: 05/17/2017] [Indexed: 11/11/2022] Open
Abstract
AIMS The aim of the present study was to assess the safety and efficacy of percutaneous mitral valve repair using the MitraClip™ device in patients with severely reduced systolic left ventricular (LV) function. METHODS AND RESULTS Among 777 MitraClip™ implantations included in the German mitral valve registry, we identified 256 patients suffering from severely reduced LV function [ejection fraction (EF) <30%] in whom successful percutaneous mitral valve repair was performed. Procedural safety, efficacy, and 1-year outcome was compared with 241 patients with preserved LV function (EF >50%) and 280 patients presenting with an EF 30-50% prior to MitraClip™ therapy. High procedural success rates, low periprocedural complication rates, and low residual mitral regurgitation grades at discharge were achieved throughout all groups. In-hospital mortality was low and comparable in all groups. After 1 year, mortality rates were 24.2% (EF <30%), 17.3% (EF 30-50%), and 18.9% (EF >50%). Major adverse cardiac or cardiovascular event rates were 29.7% (EF <30%), 24.4% (EF 30-50%), and 23.5% (EF >50%). Procedural failure was the main predictor for mortality in EF <30% patients (hazard ratio 10.38; 95% CI 3.71-29.02). Improved clinical symptoms were observed in the majority of patients in all groups. Thus, 69.5% of EF <30% patients improved by one or more New York Heart Association functional class. Compared with patients with preserved LV function, this is a significantly larger proportion (EF >50%: 56.8%; P < 0.05). Moreover, quality of life, being very poor at baseline, improved distinctively in severe heart failure patients. CONCLUSION In patients with severely reduced systolic LV function undergoing MitraClip™ therapy, procedural safety, efficacy, and clinical improvement after 1 year are comparable to patients with preserved LV function.
Collapse
Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Edith Lubos
- Heart Centre Eppendorf, University of Hamburg, Hamburg, Germany
| | - Christine S Zuern
- Clinic of Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - Jennifer Franke
- Cardiovascular Centre St. Katharinen Frankfurt, Frankfurt, Germany
| | | | | | | | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Ralf Zahn
- Heart Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Vivantes Klinikum Am Urban, Berlin, Germany, and Rostock University Medical Centre, Rostock, Germany
| | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
8
|
Keller K, von Bardeleben RS, Ostad MA, Hobohm L, Munzel T, Konstantinides S, Lankeit M. Temporal Trends in the Prevalence of Infective Endocarditis in Germany Between 2005 and 2014. Am J Cardiol 2017; 119:317-322. [PMID: 27816113 DOI: 10.1016/j.amjcard.2016.09.035] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022]
Abstract
Infective endocarditis (IE) is a potentially life-threatening disease. Little is known about temporal trends in its prevalence in Germany. In 2009, recommendations for antibiotic prophylaxis were deescalated in the revised European Society of Cardiology guideline to include only patients at high risk of IE. We selected patients with the discharge diagnosis of IE based on the International Classification of Diseases code I33 in the nationwide database of the Federal Statistical Office of Germany. We identified 94,364 patients with a diagnosis of IE from January 2005 to December 2014. Mean prevalence was 11.6 per 100,000 citizens per year in this 10-year-period. The annual IE prevalence showed a continuous small increase from 2006 to 2010 (9.5 to 10.6 IE diagnoses per 100,000 citizens) and a larger increase from 2011 to 2014 (11.1 to 14.4 IE diagnoses per 100,000 citizens; linear regression: β 2.9, 95% confidence interval 1.1 to 4.6; p = 0.006). The prevalence of IE in Germany was lower compared to the United States but higher compared to England. Overall, 15,995 patients (17%) died in hospital. Case fatality rate after a diagnosis of IE remained largely constant from 2005 to 2014. In conclusion, the annual prevalence of IE continuously increased during the observed period with more pronounced trend after the revised 2009 European Society of Cardiology guideline.
Collapse
Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Ralph S von Bardeleben
- Clinic of Cardiology I, Center of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mir A Ostad
- Clinic of Cardiology I, Center of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Clinic of Cardiology I, Center of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Munzel
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Clinic of Cardiology I, Center of Cardiology, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum (CVK), Berlin, Germany
| |
Collapse
|
9
|
von Haehling S, von Bardeleben RS, Kramm T, Thiermann Y, Niethammer M, Doehner W, Anker SD, Munzel T, Mayer E, Genth-Zotz S. Inflammation in right ventricular dysfunction due to thromboembolic pulmonary hypertension. Int J Cardiol 2010; 144:206-11. [DOI: 10.1016/j.ijcard.2009.04.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 04/07/2009] [Accepted: 04/11/2009] [Indexed: 02/02/2023]
|