Evaluation of renal function before and after percutaneous mitral valve repair. []

MedStar author(s):
Citation: Circulation: Cardiovascular Interventions. 8(1), 2015 Jan.PMID: 25593120Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter Study | Randomized Controlled TrialSubject headings: *Age Factors | *Heart Valve Prosthesis Implantation | *Kidney/me [Metabolism] | *Mitral Valve Annuloplasty | *Mitral Valve Insufficiency/pp [Physiopathology] | *Mitral Valve/su [Surgery] | *Renal Insufficiency, Chronic/pp [Physiopathology] | Administration, Cutaneous | Aged | Aged, 80 and over | Cohort Studies | Creatinine/bl [Blood] | Disease Progression | Female | Follow-Up Studies | Glomerular Filtration Rate | Humans | Male | Middle Aged | Mitral Valve Insufficiency/mo [Mortality] | Mitral Valve Insufficiency/su [Surgery] | Mitral Valve/me [Metabolism] | Renal Insufficiency, Chronic/mo [Mortality] | Renal Insufficiency, Chronic/su [Surgery] | Survival AnalysisYear: 2015Local holdings: Available online from MWHC library: 2008 - presentISSN:
  • 1941-7640
Name of journal: Circulation. Cardiovascular interventionsAbstract: BACKGROUND: Chronic kidney disease (CKD) is strongly related to outcome in cardiovascular diseases. The relationship between treatment of mitral regurgitation (MR) and renal function is not well described. We sought to evaluate renal function before and after mitral valve repair by the MitraClip device.CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00209274, NCT01931956, NCT01940120.Copyright � 2015 American Heart Association, Inc.CONCLUSIONS: Renal dysfunction is associated with lower survival in patients with severe MR even after percutaneous mitral valve repair. Reduction in MR severity by the MitraClip device is associated with improvement in renal function at 1 year in patients with baseline renal dysfunction.METHODS AND RESULTS: Patients with moderate-to-severe or severe (3+ or 4+, respectively) MR by core laboratory determination who underwent transcatheter mitral valve repair with the MitraClip device in multicenter, investigational trials were included in this study. Estimated glomerular filtration rate (eGFR) was evaluated before and at hospital discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight hundred fifty-four patients with baseline mean eGFR 61.5 +/- 23.1 mL/min/1.73 m(2) were studied, including 438 (51.3%) with eGFR > 60 mL/min/1.73 m(2) (CKD stage 1 or 2), 371 (42.6%) with eGFR 30 to 59 mL/min/1.73 m(2) (CKD stage 3), and 52 (6.1%) with eGFR < 30 mL/min/1.73 m(2) (CKD stage 4 or 5). Baseline renal dysfunction was more prevalent in older patients with a history of heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, and atrial fibrillation. Baseline eGFR was associated with 1-year survival (P < 0.001) after MitraClip repair. At 1-year follow-up, the mean change in eGFR for the overall cohort was -1.0 +/- 15.1 mL/min/1.73 m(2); for patients with CKD stage 1 or 2, stage 3, or stage 4 or 5, mean change was -4.1 +/- 16.6, +2.6 +/- 12.4, and +4.8 +/- 9.5 mL/min/1.73 m(2), respectively. Linear mixed effect modeling demonstrated a strong association between MR and eGFR, and a statistically significant improvement in eGFR in patients with CKD stage 4 or 5 associated with MR reduction to < 2+ (P = 0.007).All authors: Ailawadi G, Feldman T, Foster E, Glower D, Grayburn P, Herrmann HC, Kar S, Lim S, Sangli C, Wang A, Weissman NJFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-01-13
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25593120 Available 25593120

Available online from MWHC library: 2008 - present

BACKGROUND: Chronic kidney disease (CKD) is strongly related to outcome in cardiovascular diseases. The relationship between treatment of mitral regurgitation (MR) and renal function is not well described. We sought to evaluate renal function before and after mitral valve repair by the MitraClip device.

CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00209274, NCT01931956, NCT01940120.Copyright � 2015 American Heart Association, Inc.

CONCLUSIONS: Renal dysfunction is associated with lower survival in patients with severe MR even after percutaneous mitral valve repair. Reduction in MR severity by the MitraClip device is associated with improvement in renal function at 1 year in patients with baseline renal dysfunction.

METHODS AND RESULTS: Patients with moderate-to-severe or severe (3+ or 4+, respectively) MR by core laboratory determination who underwent transcatheter mitral valve repair with the MitraClip device in multicenter, investigational trials were included in this study. Estimated glomerular filtration rate (eGFR) was evaluated before and at hospital discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight hundred fifty-four patients with baseline mean eGFR 61.5 +/- 23.1 mL/min/1.73 m(2) were studied, including 438 (51.3%) with eGFR > 60 mL/min/1.73 m(2) (CKD stage 1 or 2), 371 (42.6%) with eGFR 30 to 59 mL/min/1.73 m(2) (CKD stage 3), and 52 (6.1%) with eGFR < 30 mL/min/1.73 m(2) (CKD stage 4 or 5). Baseline renal dysfunction was more prevalent in older patients with a history of heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, and atrial fibrillation. Baseline eGFR was associated with 1-year survival (P < 0.001) after MitraClip repair. At 1-year follow-up, the mean change in eGFR for the overall cohort was -1.0 +/- 15.1 mL/min/1.73 m(2); for patients with CKD stage 1 or 2, stage 3, or stage 4 or 5, mean change was -4.1 +/- 16.6, +2.6 +/- 12.4, and +4.8 +/- 9.5 mL/min/1.73 m(2), respectively. Linear mixed effect modeling demonstrated a strong association between MR and eGFR, and a statistically significant improvement in eGFR in patients with CKD stage 4 or 5 associated with MR reduction to < 2+ (P = 0.007).

Powered by Koha