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Dynamics of the mean transmitral pressure gradient and its impact on clinical outcomes after MitraClip
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  • Can Öztürk,
  • Kim Sprenger,
  • Noriaki Tabata,
  • Atsushi Sugiura,
  • Marcel Weber,
  • Georg Nickenig,
  • Robert Schueler
Can Öztürk
Universität Bonn
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Kim Sprenger
Universität Bonn
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Noriaki Tabata
Universität Bonn
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Atsushi Sugiura
Universität Bonn
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Marcel Weber
Universität Bonn
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Georg Nickenig
Universität Bonn
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Robert Schueler
Elisabeth-Krankenhaus-Essen GmbH Klinik für Kardiologie und Angiologie
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Abstract

Background: The impact of the increased mitral gradient (MG) on outcomes is ambiguous. Therefore, we aimed to evaluate a) periinterventional dynamics of MG, b) the impact of intraprocedural MG on clinical outcomes, and c) predictors for unfavourable MG values after MitraClip. Methods: We prospectively included patients undergoing MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after six months. 12-month survival was reassessed. Results: 175 patients (age 81.2±8.2 years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups with a threshold of intraprocedural MG of 4.5 mmHg, which was determined by the multivariate analysis for the prediction of 12-month mortality (<4.5 mmHg: Group 1, 4.5 mmHg: Group 2). Intraprocedural MG 4.5 mmHg was found to be the strongest independent predictor for 12-month mortality (HR: 2.33, p=0.03, OR: 1.70, p=0.05) and ≥3.9 mmHg was associated with adverse functional outcomes (OR: 1.96, p=0.04). The baseline leaflet-to-annulus index (>1.1) was found to be the strongest independent predictor (OR: 9.74, p=0.001) for unfavourable intraprocedural MG, followed by the number of implanted clips (p=0.01), MG at baseline (p=0.02) and central clip implantation (p=0.05). Conclusion: MG shows time-varying and condition-depended dynamics periinterventionally. Patients with persistent increased (≥4.5 mmHg) MG at discharge showed the worst functional outcomes and the highest 12-month mortality, followed by patients with an intra-hospital decrease in MG to values below 4.5 mmHg. Pre-interventional echocardiographic and procedural parameters can predict unfavourable postprocedural MG.

Peer review status:ACCEPTED

28 Jan 2021Submitted to Echocardiography
29 Jan 2021Submission Checks Completed
29 Jan 2021Assigned to Editor
02 Feb 2021Reviewer(s) Assigned
03 Mar 2021Review(s) Completed, Editorial Evaluation Pending
03 Mar 2021Editorial Decision: Revise Major
28 Mar 20211st Revision Received
30 Mar 2021Assigned to Editor
30 Mar 2021Submission Checks Completed
30 Mar 2021Reviewer(s) Assigned
15 Apr 2021Review(s) Completed, Editorial Evaluation Pending
17 Apr 2021Editorial Decision: Revise Major
25 Apr 20212nd Revision Received
26 Apr 2021Submission Checks Completed
26 Apr 2021Assigned to Editor
26 Apr 2021Reviewer(s) Assigned
10 May 2021Review(s) Completed, Editorial Evaluation Pending
20 May 2021Editorial Decision: Accept