Prognostic implication of post-MitraClip vena contracta area in heart failure patients with functional mitral regurgitation.
OBJECTIVE
Significant functional mitral regurgitation (FMR) in elderly heart failure patients is increasingly being treated by MitraClip implantation. We sought to assess the prognostic implications of the intraprocedural assessment of vena contracta area (VCA) after MitraClip therapy in such patients.


RESULTS
MitraClip therapy with intraprocedural assessment of VCA was performed in 97 heart failure patients (74±10 years; 66 men; left ventricular ejection fraction [LVEF] 31±12%; 93 patients in New York Heart Association [NYHA] functional Class III [n=59] or IV [n=34]; 86 patients with FMR severity 3+ [n=65] or 4+ [n=21]). Ninety-one patients (94%) were discharged with FMR severity ≤2+. During a median follow-up of 13.4 (interquartile range 4.6-21.1) months, 32 patients died. Multivariable Cox regression identified increasing age (HR [95% confidence interval]=1.05 [1.00-1.09], p=0.0395), a glomerular filtration rate <50 ml/min/1.73 m² (HR=2.7 [1.3-5.7], p=0.0115), and post-MitraClip VCA >25 mm² (HR=4.5 [2.1-9.5], p=0.0001) as independent predictors of mortality.


CONCLUSIONS
In heart failure patients with FMR undergoing MitraClip therapy, increasing age, impaired baseline renal function and post-MitraClip VCA >25 mm² are strongly associated with mortality. Post-MitraClip VCA may be used as intraprocedural guidance with respect to patients' long-term outcome.
Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Hannes
H
Alessandrini
Felix
F
Kreidel
Michael
M
Schlüter
Christian
C
Frerker
Tobias
T
Schmidt
Thomas
T
Thielsen
Ulrich
U
Schäfer
Karl-Heinz
KH
Kuck
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D011379:Prognosis; D013525:Surgical Instruments; D016896:Treatment Outcome