title: Impact of pulmonary hypertension on outcomes in patients with functional mitral regurgitation undergoing percutaneous edge-to-edge repair.
abstract: Preexisting pulmonary hypertension (PH) is associated with poor outcomes after surgical mitral valve repair for functional mitral regurgitation (FMR). However its clinical impact on MitraClip therapy remains unknown. The aim of this study was therefore to evaluate the impact of preexisting PH on MitraClip therapy for patients with FMR. Ninety-one consecutive patients who had FMR and who underwent the MitraClip procedure were studied. They were divided into 2 groups on the basis of pulmonary artery systolic pressure: the PH group (n = 48) and the non-PH group (n = 43). PH was defined as pulmonary artery systolic pressure >50 mm Hg using Doppler echocardiography. Procedural success (defined as magnetic resonance reduction to grade 2+ or less) and 30-day mortality were similar in the 2 groups. At 12 months, New York Heart Association functional class had improved to class I or II in most patients in the PH (from 2.9% to 94.3%) and non-PH (from 9.4% to 96.9%) groups. The mean pulmonary artery systolic pressure of the PH group significantly decreased from baseline but remained higher than that of the non-PH group (50.8 ± 15.3 vs 36.7 ± 11.6 mm Hg, p <0.001). After a mean of 25.0 ± 16.9 months of follow-up, Kaplan-Meier analysis demonstrated significantly higher all-cause mortality in the PH group. In Cox regression analysis, preexisting PH was the most powerful predictor of all-cause mortality (hazard ratio 3.731, 95% confidence interval 1.653 to 8.475, p = 0.002). In conclusion, MitraClip therapy reduced FMR and alleviated symptoms with an excellent early safety profile in the PH and non-PH groups. However, preexisting PH was associated with worse all-cause mortality.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Wen-Loong
authors.initials: WL
authors.lastname: Yeow
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Asma
authors.initials: A
authors.lastname: Hussaini
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Vinny
authors.initials: V
authors.lastname: Ram
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Moody
authors.initials: M
authors.lastname: Makar
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Gurudevan
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: karsk@cshs.org.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome