TY - JOUR
T1 - Impact of Ventricular Stroke Work Indices on Mortality in Heart Failure Patients After Percutaneous Mitral Valve Repair
AU - Osteresch, Rico
AU - Diehl, Kathrin
AU - Dierks, Patrick
AU - Schmucker, Johannes
AU - Ammar, Azza Ben
AU - Fach, Andreas
AU - Langer, Harald
AU - Eitel, Ingo
AU - Hambrecht, Rainer
AU - Wienbergen, Harm
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/5/15
Y1 - 2021/5/15
N2 - Optimal patient selection for transcatheter mitral valve repair (TMVR) remains challenging. The aim of the study was to assess the impact of left and right ventricular stroke work index (LVSWi, RVSWi) on mortality in patients with chronic heart failure (CHF) undergoing TMVR. One hundred-forty patients (median age 74 ± 9.9 years, 67.9% male) with CHF who underwent successful TMVR were included. Primary end point was defined as all-cause mortality after 16 ± 9 months of follow-up. LVSWi was calculated as: Stroke volume index (SVi) * (mean arterial pressure – postcapillary wedge pressure) * 0.0136 = g/m−1/m2. RVSWi was calculated as: SVi * (mean pulmonary artery pressure – right atrial pressure) * 0.0136 = g/m−1/m2. Receiver operating characteristic (ROC) analysis determined an optimal threshold of 24.8 g/m−1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60 to 0.81]; p = 0.001) and 8.3 g/m−1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56 to 0.78]; p = 0.006), respectively. Kaplan-Meier analysis showed significantly lower survival in patients with LVSWi ≤24.8 g/m−1/m2 (20.0% vs 39.4%; log-rank p = 0.038) and in patients with RVSWi ≤8.3 g/m−1/m2 (22.1% vs 43.7%; log-rank p = 0.026), respectively. LVSWi of ≤24.8 g/m−1/m2 and RVSWi of ≤8.3 g/m−1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p = 0.04; HR 2.52; 95% CI 1.04 to 6.1; p = 0.041). A risk-score incorporating LVSWi and RVSWi cut-off values from ROC analysis powerfully predicts long-term survival after successful TMVR (log-rank p = 0.02). In conclusion, LVSWi and RVSWi independently predict mortality in patients with CHF undergoing TMVR and might be useful in risk stratification of TMVR candidates.
AB - Optimal patient selection for transcatheter mitral valve repair (TMVR) remains challenging. The aim of the study was to assess the impact of left and right ventricular stroke work index (LVSWi, RVSWi) on mortality in patients with chronic heart failure (CHF) undergoing TMVR. One hundred-forty patients (median age 74 ± 9.9 years, 67.9% male) with CHF who underwent successful TMVR were included. Primary end point was defined as all-cause mortality after 16 ± 9 months of follow-up. LVSWi was calculated as: Stroke volume index (SVi) * (mean arterial pressure – postcapillary wedge pressure) * 0.0136 = g/m−1/m2. RVSWi was calculated as: SVi * (mean pulmonary artery pressure – right atrial pressure) * 0.0136 = g/m−1/m2. Receiver operating characteristic (ROC) analysis determined an optimal threshold of 24.8 g/m−1/m2 for LVSWi (sensitivity 80.4%, specificity 40.2%, area under the curve (AUC) 0.71 [0.60 to 0.81]; p = 0.001) and 8.3 g/m−1/m2 for RVSWi (sensitivity 67.4%, specificity 57.0%, AUC 0.67 [0.56 to 0.78]; p = 0.006), respectively. Kaplan-Meier analysis showed significantly lower survival in patients with LVSWi ≤24.8 g/m−1/m2 (20.0% vs 39.4%; log-rank p = 0.038) and in patients with RVSWi ≤8.3 g/m−1/m2 (22.1% vs 43.7%; log-rank p = 0.026), respectively. LVSWi of ≤24.8 g/m−1/m2 and RVSWi of ≤8.3 g/m−1/m2 were independent predictors for all-cause mortality (hazard ratio (HR) 2.83; 95% confidence interval (CI) 1.1 to 7.6; p = 0.04; HR 2.52; 95% CI 1.04 to 6.1; p = 0.041). A risk-score incorporating LVSWi and RVSWi cut-off values from ROC analysis powerfully predicts long-term survival after successful TMVR (log-rank p = 0.02). In conclusion, LVSWi and RVSWi independently predict mortality in patients with CHF undergoing TMVR and might be useful in risk stratification of TMVR candidates.
UR - http://www.scopus.com/inward/record.url?scp=85102262704&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2021.02.018
DO - 10.1016/j.amjcard.2021.02.018
M3 - Journal articles
C2 - 33647268
AN - SCOPUS:85102262704
SN - 0002-9149
VL - 147
SP - 101
EP - 108
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -