Pulmonary Venous Waveforms Predict Rehospitalization and Mortality After Percutaneous Mitral Valve Repair.
Citation: Jacc: Cardiovascular Imaging. 12(10):1905-1913, 2019 10.PMID: 30219407Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiac Catheterization/mo [Mortality] | *Echocardiography, Doppler | *Echocardiography, Transesophageal | *Heart Valve Prosthesis Implantation/mo [Mortality] | *Mitral Valve Insufficiency/su [Surgery] | *Mitral Valve/su [Surgery] | *Patient Readmission | *Pulmonary Veins/dg [Diagnostic Imaging] | Aged | Aged, 80 and over | Atrial Function, Left | Atrial Pressure | Cardiac Catheterization/ae [Adverse Effects] | Cause of Death | Female | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Male | Middle Aged | Mitral Valve Insufficiency/dg [Diagnostic Imaging] | Mitral Valve Insufficiency/mo [Mortality] | Mitral Valve Insufficiency/pp [Physiopathology] | Mitral Valve/dg [Diagnostic Imaging] | Mitral Valve/pp [Physiopathology] | Predictive Value of Tests | Pulmonary Circulation | Pulmonary Veins/pp [Physiopathology] | Retrospective Studies | Risk Assessment | Risk Factors | Time Factors | Treatment OutcomeYear: 2019ISSN:- 1876-7591
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 30219407 | Available | 30219407 |
BACKGROUND: The effects of hemodynamic changes during percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Vascular, Santa Clara, California) are incompletely characterized.
CONCLUSIONS: PV waveforms are important markers of procedural success after PMVR. Our data show intraprocedural PV waveforms may predict rehospitalization and mortality after PMVR. A larger, multicenter cohort will be important to clarify this relationship.
Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
METHODS: The authors retrospectively reviewed records and intraprocedural transesophageal echocardiograms of 115 consecutive patients (age 76 +/- 12 years) who underwent PMVR for mitral regurgitation (MR) from May 2013 to January 2017 at Emory University Hospital. They assessed intraprocedural PV waveforms for improvement in morphology, measured change in MR grade by semiquantitative methods, evaluated invasive changes in left atrial pressure (LAP) and V-wave, and compared with 30-day and 1-year rehospitalization and all-cause mortality.
OBJECTIVES: In this study, the authors hypothesized that intraprocedural improvement of pulmonary venous (PV) waveforms are predictive of improved outcomes. In this report, they analyzed intraprocedural invasive and echocardiographic changes with respect to rehospitalization and mortality.
RESULTS: Ninety-three cases (80%) had PV waveforms before and after clip placement sufficient for analysis, of which 67 (73%) demonstrated intraprocedural improvement in PV morphology and 25 (27%) did not. At 24 months, 57 (85%) of those with PV improvement were living, compared with only 10 (40%) of those without improvement. Proportional hazards models demonstrated a significant survival advantage in those with PV improvement (hazard ratio [HR] = 0.28, 95% confidence interval [CI] 0.08 to 0.93, p = 0.038). By multivariable analysis, PV improvement predicted reduced 1-year cardiac rehospitalization (odds ratio [OR] = 0.18, p = 0.044). Intraprocedural assessment of MR grade and invasive hemodynamics did not consistently predict mortality and rehospitalization.
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