Abstract 16328: Residual Pulmonary Hypertension Persist Even in Patients With Successful MitraClip and Adversely Affect Heart Failure Events
Background: Pulmonary hypertension (PH) is common among patients requiring mitral valve treatment, and even mild PH adversely affect outcome. The aim of the study was to investigate the response of pulmonary artery pressure (PAP) in patients undergoing MitraClip and determine the prognostic effect of residual PH.
Methods: From 2007 to 2013, 121 consecutive patients undergoing the MitraClip were retrospectively reviewed. Patients were categorized into two groups according to residual PH defined by post-procedural PAP obtained by transthoracic echocardiography. The primary endpoint was combined endpoints of all-cause mortality, left ventricular assist device implantation, shock, mitral valve surgery, New York Heart Association III-IV, re-hospitalization due to heart failure, new onset atrial fibrillation requiring hospitalization, ventricular arrhythmia, mechanical ventilation more than 48 hours, admission longer than two weeks. Patients with existing pulmonary disease or systemic disease affecting PAP were excluded.
Results: Forty seven of 86 had residual PH. Patients with residual PH had higher pre-procedural PAP, and higher six months PAP than those without residual PH (pre-procedural, 50.3±13.4 vs 42.2±9.8 mmHg, p=0.003; at six months, 45.4±14.0 vs 34.7±9.9 mmHg, p<0.001, respectively). Patients without residual PH had an immediate decrease in PAP (42.2±9.8 vs 31.5±5.9 mmHg, p<0.001), while patients with residual PH had a decrease in PAP at a month, but not a significant change immediate post-procedure (pre- to post-procedure, 50.3±13.4 to 49.7±7.2 mmHg p=0.808; post-procedure to a month, 49.7±7.2 to 43.3±10.3 mmHg, p<0.001). Primary combined endpoint at two years met 26.5%. The Kaplan-Meier Curve (Log rank method) showed patients with residual PH had poorer outcome on primary endpoint (p=0.017). The independent predictor of the primary endpoint evaluated by multivariate analysis (Cox proportional hazard) was post-procedural PH [hazard ratio 2.9, 95% confidence interval 1.1-7.9].
Conclusion: Patients with residual PH have higher rate of adverse events associated with heart failure even with successful MR reduction, and additional medical intervention, such as pulmonary vasodilator, should be considered.
Author Disclosures: M. Saji: None. G. Ailawadi: Consultant/Advisory Board; Modest; Abbott Vascular. J. Dent: None. D.S. Lim: Consultant/Advisory Board; Modest; Abbott Vascular.
- © 2014 by American Heart Association, Inc.