ESC heart failure | 2021
Percutaneous edge-to-edge mitral valve repair for mitral regurgitation improves heart failure symptoms in heart failure with preserved ejection fraction patients.
Abstract
AIMS\nTherapeutic options for patients with heart failure with preserved ejection fraction (HFpEF) are sparse. Mitral regurgitation (MR) is a common feature of HFpEF and worsens heart failure symptoms and prognosis. Our study examines the outcome of patients with preserved left ventricular ejection fraction (LVEF) and elevated left atrial (LAP) or left ventricular filling pressures (LVEDP), indicative of HFpEF, after undergoing percutaneous edge-to-edge mitral valve repair (pMVR) for moderate-severe MR.\n\n\nMETHODS AND RESULTS\nTwo hundred eleven patients with preserved LVEF (>50%), who underwent pMVR, were dichotomized by LAP (<\u2009/\u2009≥15\xa0mmHg) and LVEDP (<\u2009/\u2009≥16\xa0mmHg). Forty-nine per cent of patients showed elevated LAP, and LVEDP was elevated in 55%, both indicating HFpEF. Patients with elevated filling pressures featured typical clinical characteristics of HFpEF, higher N-terminal pro-brain natriuretic peptide levels (5544.9\xa0pg/mL in high LAP group vs. 3071.7\xa0pg/mL in normal LAP group, P\xa0=\xa00.06; 5061.0\xa0pg/mL in high LVEDP group vs. 3230.3\xa0pg/mL in normal LVEDP group, P\xa0=\xa00.08), and higher prevalence of pulmonary hypertension (mean pulmonary artery pressure 36.4\xa0mmHg in high LAP group vs. 26.3\xa0mmHg in normal LAP group, P\xa0<\xa00.001; 35.2\xa0mmHg in high LVEDP group vs. 29.7\xa0mmHg in normal LVEDP group, P\xa0=\xa00.004) and atrial fibrillation (78.8% in normal LAP group vs. 61.0% in high LAP group, P\xa0=\xa00.04; 75.3% in high LVEDP group vs. 67.5% in normal LVEDP group, P\xa0=\xa00.25). Pre-treatment MR grade and New York Heart Association (NYHA) class were similar in both normal filling pressure and HFpEF groups. pMVR in HFpEF patients achieved effective heart failure symptom relief comparable with patients with normal filling pressures: significant decrease of MR grade and NYHA class, as well as significant reduction of heart failure hospitalizations 12\xa0months after compared with 12\xa0months before MitraClip.\n\n\nCONCLUSION\nPercutaneous edge-to-edge mitral valve repair for moderate-severe MR is an effective treatment option for symptom relief in HFpEF patients.