Pulmonary artery pressures and outcomes after MitraClip

Abstract

Aims We evaluated the impact of MitraClip on systolic pulmonary artery pressure (sPAP) and the effects of baseline sPAP on outcomes. Methods and results In a cohort of patients who underwent MitraClip implantation, three groups were defined according to pre-procedure sPAP levels. Clinical and echocardiographic data were compared. The study included 177 patients: 59 had severe pulmonary hypertension (PHT), 96 had mild to moderate PHT, and 22 had no PHT. In patients with pre-existing severe PHT, sPAP was reduced from 70.8 ± 9.2 to 56.8 ± 13.7 mmHg (P < 0.001), sPAP remained unchanged in patients with mild to moderate PHT but was significantly increased from 30.8 ± 4.3 to 38.6 ± 8.3 mmHg in the no-PHT group (P < 0.001). Improvement of sPAP was observed in 77% of severe PHT group, while worsening of sPAP was more common among patients with no-PHT [57% compared with 33% among the mild to moderate PHT and 7% in the severe PHT group, respectively, (P < 0.001)]. One year survival was similar among the study groups. Conclusions MitraClip decreases PHT among patients with severe PHT. A concerning finding is that most patients with no-PHT increase their sPAP.

Should the mean left atrial pressure be the ultimate goal after TMVR?

“…After a successful TMVR, several acute hemodynamic changes occur, resulting in changes of the MLAP 2 . Besides the decrease in the regurgitant volume, changes in the diastolic mean gradient, the pulmonic vein flow, the degree of iatrogenic interatrial shunt or the pulmonic vascular resistance and pressures may be seen 3,4 . In the present study, a change of the mean LAP from 19 mmHg at baseline to 17 mmHg following MitraClip deployment was significantly associated with improvement in patient's NYHA functional status at 30 days after adjustments for age and sex.…”

Novelties in Pulmonary Hypertension Secondary to Left Heart Disease

“…In a sensitivity analysis published later 119 , the primary outcome was reduced irrespective of baseline systolic PAP although in general, patients with systolic PAP ≥ 50 mmHg before intervention had higher two-year rates of death or hospitalization compared to those with systolic PAP < 50 mmHg (68.8% versus 49.1%, p = 0.002). In another study of patients following MitraClip implantation 120 , systolic PAP significantly decreased in patients with severe PH, but surprisingly remained unchanged in those with mild PH, and even increased in patients without PH at baseline. In-hospital outcomes did not vary significantly according to pre-existing PH in another observational study of 1037 patients undergoing MitraClip procedure 121 .…”