Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement
(2019) In International Journal of Cardiology 294. p.32-36- Abstract
Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR. Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed. Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01–1.65, p = 0.04). Using persistent ≤mild MR as the reference, when moderate/severe MR persisted or if MR... (More)
Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR. Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed. Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01–1.65, p = 0.04). Using persistent ≤mild MR as the reference, when moderate/severe MR persisted or if MR worsened from ≤mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17–2.34, p = 0.04; adjusted HR 1.97, CI 1.29–3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to ≤mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75–1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17–0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27–3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08–7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32–7.78. p < 0.0001) were associated with MR worsening. Conclusions: Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to ≤mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.
(Less)
- author
- Feldt, Kari ; De Palma, Rodney ; Bjursten, Henrik LU ; Petursson, Petur ; Nielsen, Niels Erik ; Kellerth, Thomas ; Jönsson, Anders ; Nilsson, Johan ; Rück, Andreas and Settergren, Magnus
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Long-term, Mitral regurgitation, Prognosis, Survival, TAVR
- in
- International Journal of Cardiology
- volume
- 294
- pages
- 5 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85072058172
- pmid:31399298
- ISSN
- 0167-5273
- DOI
- 10.1016/j.ijcard.2019.07.075
- project
- Outcome after transcatheter valve interventions
- language
- English
- LU publication?
- yes
- id
- 0251ef5e-331e-49ac-860a-7f6371e93afa
- date added to LUP
- 2019-09-16 12:24:09
- date last changed
- 2024-06-12 00:31:04
@article{0251ef5e-331e-49ac-860a-7f6371e93afa, abstract = {{<p>Background: The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR. Methods: The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed. Results: 1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01–1.65, p = 0.04). Using persistent ≤mild MR as the reference, when moderate/severe MR persisted or if MR worsened from ≤mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17–2.34, p = 0.04; adjusted HR 1.97, CI 1.29–3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to ≤mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75–1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17–0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27–3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08–7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32–7.78. p < 0.0001) were associated with MR worsening. Conclusions: Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to ≤mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.</p>}}, author = {{Feldt, Kari and De Palma, Rodney and Bjursten, Henrik and Petursson, Petur and Nielsen, Niels Erik and Kellerth, Thomas and Jönsson, Anders and Nilsson, Johan and Rück, Andreas and Settergren, Magnus}}, issn = {{0167-5273}}, keywords = {{Long-term; Mitral regurgitation; Prognosis; Survival; TAVR}}, language = {{eng}}, pages = {{32--36}}, publisher = {{Elsevier}}, series = {{International Journal of Cardiology}}, title = {{Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement}}, url = {{http://dx.doi.org/10.1016/j.ijcard.2019.07.075}}, doi = {{10.1016/j.ijcard.2019.07.075}}, volume = {{294}}, year = {{2019}}, }