Edge-to-edge treatment has proven to be a safe and effective technique in follow-up, decreasing mortality and hospitalizations for heart failure when a good result is achieved.
The MitraScore was developed to assess the outcome at the end of the procedure. In that sense, results <3 represent mild mitral regurgitation, which would be related to lower mortality, although this has not yet been validated.
Researchers conducted a prospective analysis of the MITRA-PRO Registry, including 1491 patients with primary, secondary, or mixed severe mitral regurgitation. Out of all patients who underwent edge-to-edge treatment, 1059 had a MitraScore ≤3 (71%) and 432 ≥4.
The devices used were MITRACLIP XT, NT, NTR, and XTR.
The groups were similar: mean age was 78 years; 43% of subjects were women; EUROScore = 22; 86% of patients had hypertension, 28% had diabetes, 60% had coronary artery disease, 18% had undergone myocardial revascularization surgery (MRS), 7% had undergone transcatheter aortic valve replacement (TAVR), 70% experienced atrial fibrillation, 22% had a permanent pacemaker, 17% had an Automatic Implantable Cardioverter-Defibrillator (AICD), and 12% had received cardiac resynchronization therapy. More than 50% had moderate or severe tricuspid regurgitation and their ejection fraction was 44%.
The cause of mitral regurgitation was secondary in 56% of the patients, degenerative in 28%, and mixed in the rest of the subjects studied.
There were no differences in terms of pharmacological treatment received.
In-hospital mortality (1.6% vs.1.9%) and MACCE were also similar.
At the one-year follow-up, mortality was lower in patients with MitraScore 3 (14.6% vs. 22.1%; hazard ratio [HR]): 1.63; 95% confidence interval [CI]: 1.25-2.13; p < 0.001), and so were the composite of death and rehospitalizations (31.5% vs. 40.8%; HR: 1.73; 95% CI: 1.35-2.21 p<0.0001), and rehospitalizations and need for reintervention.
Conclusion
The presence of intra-procedural residual mitral regurgitation analyzed by MitraScore after edge-to-edge therapy predicts mortality and rehospitalization at one year. Thus, the MitraScore improves the assessment of residual mitral regurgitation during edge-to-edge therapy and may improve patient survival.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Reference: Peter Boekstegers, et al. J Am Coll Cardiol Intv 2023;16:574–585.
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