Impact of systolic dominant pulmonary venous flow morphology on outcomes after mitral transcatheter edge-to-edge repair

Sahar Samimi, Taha Hatab, Rody Bou Chaaya, Chloe Kharsa, Fatima Qamar, Nadeen Faza, Stephen H. Little, Marvin D. Atkins, Michael J. Reardon, Neal S. Kleiman, Sherif F. Nagueh, William A. Zoghbi, Syed Zaid, Sachin S. Goel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The prognostic significance of intraprocedural pulsed-wave Doppler analysis of pulmonary venous flow (PVF) during mitral transcatheter edge-to-edge repair (TEER) remains understudied. We aimed to investigate the prognostic value of systolic dominant-PVF (SD-PVF) morphology post-TEER. Methods: In a retrospective analysis from December 2019 to December 2022, patients undergoing mitral TEER were categorized into SD-PVF and systolic blunting (SB)-PVF groups based on post-TEER morphology. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization at 1 year. We investigated the association of PVF morphology post-TEER with the primary endpoint at 1 year using Cox regression and compared the prognostic accuracy of PVF variables through receiver operating characteristic (ROC) curve analysis. Results: Among 187 patients (mean age 76.4 ± 10.5 years, 51.3% primary etiology), residual mitral regurgitation (MR) ≤mild was observed in 147 (82.4%) patients and 105 (56.2%) had SD-PVF post-TEER. Patients with SD-PVF had a lower incidence of >2+ residual MR after clip deployment, at 30 days (2.1% vs. 13.1%; p = 0.005) and at 1 year (1.4% vs. 9%; p = 0.08). SD-PVF post-TEER was independently associated with the primary endpoint (HR = 0.59, 95% CI = 0.39–0.87; p = 0.009). ROC curve analysis of the prognostic accuracy of SD-PVF demonstrated an AUC of 0.64 (95% CI = 0.54–0.73), comparable to other quantitative measures of PVF. Conclusion: Assessing PVF morphology after clip deployment offers a simple prognostic tool for patients undergoing mitral TEER. Multicenter cohorts will be necessary to further investigate its prognostic value.

Original languageEnglish (US)
Pages (from-to)1027-1036
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume104
Issue number5
DOIs
StatePublished - Nov 1 2024

Keywords

  • mitral regurgitation
  • mitral transcatheter edge-to-edge repair
  • pulmonary venous flow
  • Mitral Valve/physiopathology
  • Predictive Value of Tests
  • Risk Assessment
  • Humans
  • Risk Factors
  • Male
  • Treatment Outcome
  • Systole
  • Echocardiography, Doppler, Pulsed
  • Pulmonary Circulation
  • Cardiac Catheterization
  • Time Factors
  • Blood Flow Velocity
  • Aged, 80 and over
  • Female
  • Retrospective Studies
  • Aged
  • Pulmonary Veins/physiopathology
  • Mitral Valve Insufficiency/physiopathology

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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