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20. Prognostic value of left ventricular global longitudinal strain in transcatheter edge-to-edge repair for chronic primary mitral regurgitation.

Author

Shechter, Alon, Hong, Gloria J, Kaewkes, Danon, Patel, Vivek, Visrodia, Parth, Tacon, P Ryan, Koren, Ofir, Koseki, Keita, Nagasaka, Takashi, Skaf, Sabah, Makar, Moody, Chakravarty, Tarun, Makkar, Raj R, and Siegel, Robert J

Subjects
HOSPITAL care, DESCRIPTIVE statistics, RETROSPECTIVE studies, CAUSES of death, HEART failure, SEVERITY of illness index, MITRAL valve insufficiency, LONGITUDINAL method, MEDICAL records, ACQUISITION of data, COMORBIDITY
Abstract

Aims Left ventricular global longitudinal strain (LVGLS) is a known outcome predictor in transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic primary MR. Methods and results We conducted a single-centre, retrospective analysis of 323 consecutive patients undergoing isolated, first-time procedures. Stratified by baseline LVGLS quartiles (≤−19%, −18.9% to −16%, −15.9% to −12%, >−12%), the cohort was evaluated for the primary composite outcome of all-cause mortality or heart failure hospitalizations, as well as secondary endpoints consisting of mitral reinterventions and the persistence of significant residual MR and/or functional disability—all along the first year after intervention. Subjects with worse (i.e. less negative) LVGLS exhibited higher comorbidity, more advanced HF, and elevated procedural risk. Post-TEER, those belonging to the worst LVGLS quartile group sustained increased mortality (16.9% vs. 6.3%, Log-Rank P = 0.005, HR 1.75, 95% CI 1.08–4.74, P = 0.041) and, when affected by LV dysfunction/dilatation, more primary outcome events (21.1% vs. 11.5%, Log-Rank P = 0.037, HR 1.68, 95% CI 1.02–5.46, P = 0.047). No association was demonstrated between baseline LVGLS and other endpoints. Upon exploratory analysis, 1-month post-procedural LVGLS directly correlated with and was worse than its baseline counterpart by 1.6%, and a more impaired 1-month value—but not the presence/extent of deterioration—conferred heightened risk for the primary outcome. Conclusion TEER for chronic primary MR is feasible, safe, and efficacious irrespective of baseline LVGLS. Yet, worse baseline LVGLS forecasts a less favourable post-procedural course, presumably reflecting a higher-risk patient profile. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Artificial Intelligence Trumps TAVI2-SCORE and CoreValve Score in Predicting 1-Year Mortality Post-Transcatheter Aortic Valve Replacement

Author

Agasthi, Pradyumna, Ashraf, Hasan, Pujari, Sai Harika, Girardo, Marlene E., Tseng, Andrew, Mookadam, Farouk, Venepally, Nithin R., Buras, Matthew, Khetarpal, Banveet K., Allam, Mohamed, Eleid, Mackram F., Greason, Kevin L., Beohar, Nirat, Siegel, Robert J., Sweeney, John, Fortuin, Floyd D., Holmes, David R., Jr, and Arsanjani, Reza

Published
2021
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29. Preprocedural transthoracic echocardiography for predicting outcomes of transcatheter edge-to-edge repair for chronic primary mitral regurgitation

Author

Shechter, Alon, primary, Patel, Vivek, additional, Kaewkes, Danon, additional, Lee, Mirae, additional, Hong, Gloria J, additional, Koren, Ofir, additional, Chakravarty, Tarun, additional, Koseki, Keita, additional, Nagasaka, Takashi, additional, Skaf, Sabah, additional, Makar, Moody, additional, Makkar, Raj R, additional, and Siegel, Robert J, additional

Published
2023
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30. Implications of Mitral Annular Disjunction in Patients Undergoing Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation

Author

Shechter, Alon, primary, Vaturi, Mordehay, additional, Hong, Gloria J., additional, Kaewkes, Danon, additional, Patel, Vivek, additional, Seok, Minji, additional, Nagasaka, Takashi, additional, Koren, Ofir, additional, Koseki, Keita, additional, Skaf, Sabah, additional, Makar, Moody, additional, Chakravarty, Tarun, additional, Makkar, Raj R., additional, and Siegel, Robert J., additional

Published
2023
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42. Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation.

Author

Shechter, Alon, Kaewkes, Danon, Lee, Mirae, Makar, Moody, Patel, Vivek, Koren, Ofir, Koseki, Keita, Nagasaka, Takashi, Skaf, Sabah, Chakravarty, Tarun, Makkar, Raj R, and Siegel, Robert J

Subjects
MITRAL valve insufficiency, CARDIAC catheterization, ECHOCARDIOGRAPHY, VENTRICULAR ejection fraction, RETROSPECTIVE studies, FISHER exact test, MANN Whitney U Test, T-test (Statistics), PEARSON correlation (Statistics), DESCRIPTIVE statistics, CHI-squared test, KAPLAN-Meier estimator, DATA analysis software, PROPORTIONAL hazards models
Abstract

Aims To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. Methods and results We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75–88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10–0.78, P = 0.016). Conclusion LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Comparison of prognostic value among echocardiographic surrogates of right ventricular–pulmonary arterial coupling: A three‐dimensional echocardiographic study.

Author

Kuwajima, Ken, Ogawa, Mana, Ruiz, Irving, Yamane, Takafumi, Hasegawa, Hiroko, Yagi, Nobuichiro, Rader, Florian, Siegel, Robert J., and Shiota, Takahiro

Subjects
HEART disease prognosis, HEART disease related mortality, BLOOD pressure, ECHOCARDIOGRAPHY, VENTRICULAR ejection fraction, RIGHT heart ventricle, SYSTOLIC blood pressure, MULTIVARIATE analysis, PULMONARY artery, RETROSPECTIVE studies, ACQUISITION of data, GLOBAL longitudinal strain, MEDICAL records, HOSPITAL care, DESCRIPTIVE statistics, HEART physiology, STROKE volume (Cardiac output)
Abstract

Objectives: Right ventricular (RV)–pulmonary arterial (PA) coupling is important in various cardiac diseases. Recently, several echocardiographic surrogates for RV–PA coupling have been proposed and reported to be useful in predicting outcomes. However, it remains unclear which surrogate is the most clinically relevant. This study aimed to comprehensively compare the prognostic value of different echocardiographic RV–PA coupling surrogates. Methods: We retrospectively reviewed 242 patients with various cardiac conditions who underwent comprehensive transthoracic echocardiography with three‐dimensional RV data. In addition to conventional parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and PA systolic pressure (PASP), we analyzed RV free wall and global longitudinal strain (FWLS and GLS). We also obtained RV ejection fraction (RVEF), stroke volume (SV), and end‐systolic volume (ESV) using three‐dimensional RV analysis. RV–PA coupling surrogates were calculated as TAPSE/PASP, FAC/PASP, FWLS/PASP, GLS/PASP, RVEF/PASP, and SV/ESV. The study endpoint was a composite outcome of all‐cause death or cardiovascular hospitalization within 1 year. Results: In multivariable analysis, all the RV–PA coupling surrogates were independent predictors of the outcome. Among the surrogates, the model with TAPSE/PASP showed the lowest prognostic value in model fit and discrimination ability, whereas the model with RVEF/PASP exhibited the highest prognostic value. The partial likelihood ratio test indicated that the model with RVEF/PASP was significantly better than the model with TAPSE/PASP (p <.024). Conclusion: All the RV–PA coupling surrogates were independent predictors of the outcome. Notably, RVEF/PASP had the highest prognostic value among the surrogates. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Outcome Prediction score for mitral transcatheter edge-to-edge repair in patients with concomitant significant tricuspid regurgitation

Author

Shechter, Alon, primary, Kaewkes, Danon, additional, Patel, Vivek, additional, Vaturi, Mordehay, additional, Wangmang, Felix, additional, Koseki, Keita, additional, Koren, Ofir, additional, Nagasaka, Takashi, additional, Makar, Moody, additional, Chakravarty, Tarun, additional, Skaf, Sabah, additional, Makkar, Raj R., additional, and Siegel, Robert J., additional

Published
2023
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45. Correlates and Prognostic Implications of LVEF Reduction After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation

Author

Shechter, Alon, primary, Kaewkes, Danon, additional, Lee, Mirae, additional, Makar, Moody, additional, Patel, Vivek, additional, Koren, Ofir, additional, Koseki, Keita, additional, Nagasaka, Takashi, additional, Skaf, Sabah, additional, Chakravarty, Tarun, additional, Makkar, Raj R, additional, and Siegel, Robert J, additional

Published
2023
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