title: Right ventricular evaluation to improve survival outcome in patients with severe functional mitral regurgitation and advanced heart failure undergoing MitraClip therapy.
abstract: BACKGROUND
  Percutaneous mitral valve repair (PMVR) is a new option for high risk patients with functional mitral regurgitation (FMR) and severely depressed left ventricular (LV) function who are not responding to optimal medical therapy. However patients with end stage heart failure have a high mortality rate despite MitraClip implantation. We sought to identify right ventricular (RV) echocardiographic predictors of outcome in a large cohort of patients with severe FMR and advanced heart failure in order to select the most appropriate candidate who could benefit from this treatment.
  
  
  METHODS
  169 consecutive high surgical risk patients affected by severe FMR underwent PMVR with the MitraClip System. The primary end-point was cardiovascular mortality at the longest available follow-up.
  
  
  RESULTS
  The survival free from cardiac death was 97.6% at 30days, 86.7% at 1year, 71.5% at 2years and 61.6% at 3years. Patients who died were significantly older and had more severe comorbidities and signs of more advance heart failure. Independent predictors of cardiovascular mortality were severely impaired renal function [glomerular filtration rate (GFR)<30ml/min; OR=5.46, 95%CI=1.43-20.84, (p=0.01)] and RV systolic dysfunction [peak systolic velocity tissue Doppler imaging (PSVtdi)<9.5cm/s; OR=0.57, 95%CI=0.39-0.82, (p=0.003)].
  
  
  CONCLUSIONS
  Our study shows the importance of RV systolic function evaluation for the risk stratification of patients with FMR and advanced heart failure undergoing PMVR. Severe right ventricular failure identifies patients with an increased risk for cardiovascular mortality despite MitraClip treatment. RV PSVtdiis the best independent predictor of outcome in these end-stage patients for a threshold value of 9.5cm/s.
authors: Azienda Ospedaliero-Universitaria Pisana, PISA, Italy. Electronic address: crigiannini@hotmail.it.
authors: Cristina
authors: C
authors: Giannini
authors: Azienda Ospedaliero-Universitaria Pisana, PISA, Italy.
authors: Francesca
authors: F
authors: Fiorelli
authors: San Raffaele Scientific Institute, Milan, Italy.
authors: Antonio
authors: A
authors: Colombo
authors: Azienda Ospedaliero-Universitaria Pisana, PISA, Italy.
authors: Marco
authors: M
authors: De Carlo
authors: Second University of Naples, Naples, Italy.
authors: Sara Hana
authors: SH
authors: Weisz
authors: San Raffaele Scientific Institute, Milan, Italy.
authors: Eustachio
authors: E
authors: Agricola
authors: San Raffaele Scientific Institute, Milan, Italy.
authors: Cosmo
authors: C
authors: Godino
authors: Maria Cecilia Hospital, Cotignola, Italy.
authors: Fausto
authors: F
authors: Castriota
authors: Second University of Naples, Naples, Italy.
authors: Paolo
authors: P
authors: Golino
authors: Azienda Ospedaliero-Universitaria Pisana, PISA, Italy.
authors: Anna Sonia
authors: AS
authors: Petronio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D012720:Severity of Illness Index; D013525:Surgical Instruments / Q000639:trends; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Percutaneous mitral valve repair