ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Impact of pulmonary hypertension dynamics and residual mitral regurgitation shortly after M-TEER on long-term outcomes: insights from a prospective registry.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.
aimsTo evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.
methodsA total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.
resultsOverall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38 months, time to HFH 74 vs. 44 months, and time to composite endpoint 49 vs. 26 months, all p < 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58 months, p = 0.027; time to HFH 74 months, p = 0.004; time to composite endpoint 50 months, p = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.
conclusionAssessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. Its combination with the post-procedural level of MR can easily identify patients at low or high risk of subsequent adverse outcomes.
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