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Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome.

Authors
  • Muratori, Manuela1
  • Fusini, Laura2
  • Tamborini, Gloria2
  • Ghulam Ali, Sarah2
  • Gripari, Paola2
  • Fabbiocchi, Franco2
  • Salvi, Luca2
  • Trabattoni, Piero2
  • Roberto, Maurizio2
  • Agrifoglio, Marco3
  • Alamanni, Francesco3
  • Bartorelli, Antonio L4
  • Pepi, Mauro2
  • 1 Centro Cardiologico Monzino IRCCS, Milan, Italy. Electronic address: [email protected] , (Italy)
  • 2 Centro Cardiologico Monzino IRCCS, Milan, Italy. , (Italy)
  • 3 Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. , (Italy)
  • 4 Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy. , (Italy)
Type
Published Article
Journal
International journal of cardiology
Publication Date
Jan 15, 2020
Volume
299
Pages
228–234
Identifiers
DOI: 10.1016/j.ijcard.2019.07.060
PMID: 31353154
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Mitral regurgitation (MR) is frequently associated with severe aortic stenosis, but its influence on outcomes after transcatheter aortic valve implantation (TAVI) remains controversial. This study sought to assess the baseline etiology and degree of MR in TAVI population, identify the predictors of MR changes and investigate the clinical and prognostic impact of baseline MR at mid and long-term follow-up. We enrolled 572 consecutive patients who underwent TAVI. MR degree and etiology were evaluated by echocardiography at baseline and 1-year follow-up. Clinical outcomes were obtained up to 3-year follow-up. At baseline, 168 patients (29%) had moderate-to-severe MR (MR ≥ 2). Organic MR was more frequently associated with MR ≥ 2 (MR < 2: 20%, MR ≥ 2: 43%, p < 0.001). Relevant MR had improved more in functional MR (79%) compared to organic MR (50%, p = 0.001). At the multivariate analysis, the coexistence of coronary artery disease (p = 0.026), absence of atrial fibrillation (p = 0.038) and functional etiology (p = 0.025) were predictors of MR improvement after TAVI. Patients with baseline MR ≥ 2 had a higher mortality rate than those with MR < 2 at 1-year and 3-year follow-up. Moreover, a landmark analysis starting from 1-year to 3-year follow-up, demonstrated that organic MR was associated with an increased risk of mortality throughout 3-year follow-up compared with functional MR, irrespective of MR severity. Baseline MR ≥ 2 in TAVI patients was associated with early and late mortality rate. At 1-year, significant improvement in MR severity was observed mainly in patients with functional MR ≥ 2. Organic MR ≥ 2 had a negative impact on 3-year, but not 1-year, mortality rate. Copyright © 2019 Elsevier B.V. All rights reserved.

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