Implication of pulmonary hypertension in patients undergoing MitraClip MitraClip therapy: results from the German transcatheter mitral valve interventions ( TRAMI TRAMI ) registry

摘要

Abstract Aims We sought to evaluate the impact of pulmonary hypertension on outcomes following MitraClip therapy. Methods and results The 643 patients in the TRAnscatheter Mitral valve Interventions ( TRAMI ) registry were divided into three groups according to echocardiographically graded systolic pulmonary artery pressure ( sPAP ) (Group?1: patients with sPAP of ≤36? mmHg ; Group?2: patients with sPAP of 37–50? mmHg ; Group?3: patients with sPAP of 50? mmHg ) and followed for 1?year. Recent cardiac decompensation, aortic valve disease and tricuspid valve insufficiency were observed more frequently in patients with higher sPAP . Furthermore, logEuroSCORE , Society of Thoracic Surgeons score and age were higher with rising sPAP values. No differences were observed in mitral regurgitation ( MR ) severity, co‐morbidities or clinical findings (New York Heart Association class, 6‐min walking distance). Reduction to MR of grade 1 or lower was achieved more often in patients with lower sPAP levels ( P ?=?0.01). In Groups 2 and 3, sPAP was reduced significantly. Major adverse cardiac or cardiovascular events ( MACCEs ) occurring in hospital (death, myocardial infarction, stroke; 4% in each group), as well as 30‐day rates of MACCEs (6.1% in Group?1, 11.9% in Group?2, 12.4% in Group?3) and rehospitalization (18.9% in Group?1, 24.8% in Group?2, 24.8% in Group?3) did not differ significantly. At 1?year, differences in rates of mortality and MACCEs (20.3% in Group?1, 33.1% in Group?2, 34.7% in Group?3; P ??0.01) were significant. Both Groups 2 [hazard ratio ( HR ) 1.81, P ?=?0.0122] and 3 ( HR 1.85, P ?=?0.0092) were independently predictive of death. Rehospitalization rates did not differ during follow‐up. Conclusions Despite higher mortality in patients with elevated sPAP , these data suggest the safety, feasibility and benefit of MitraClip therapy even in advanced stages of disease. An early approach might prevent the progress of pulmonary hypertension and improve outcomes.