Safety and efficacy of <scp>MitraClip</scp>™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (<scp>TRAMI</scp>) registry

After MitraClip implantation, annual rate of rehospitalization for decompensated heart failure was reduced by 65.8%. Baseline left ventricular ejection fraction, baseline troponin T and pre-procedural NYHA functional class are independent predictors for rehospitalization within the first year after MitraClip implantation. Patients readmitted for decompensated heart failure after MitraClip implantation had a 2.3-fold increased risk of all-cause mortality and a 3.3-fold increased risk of cardiovascular mortality compared to patients not requiring rehospitalization.

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“…The impact of severely impaired LVEF in patients undergoing MitraClip implantation has been assessed by Geis et al . in the TRAMI registry.…”

Section: Discussionmentioning

confidence: 99%

Predictors of rehospitalization after percutaneous edge‐to‐edge mitral valve repair by MitraClip implantation

Keßler

Seeger

Muche

et al. 2018

European J of Heart Fail

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“…No reduction in the primary endpoint of all-cause mortality or HF hospitalizations was shown in MITRA-FR, whereas a significant reduction in HF hospitalizations (primary endpoint) as well as in mortality alone was observed in COAPT ( Figure 4). 109,110 Functional tricuspid regurgitation may contribute to right heart failure and HF severity and poor prognosis. Compared with MITRA-FR patients, those in COAPT had more severe mitral regurgitation, less dilated left ventricles, and no signs of right ventricular failure.…”

Section: Percutaneous Treatment Of Mitral Regurgitationmentioning

confidence: 99%

Highlights in heart failure

et al. 2019

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Heart failure (HF) remains a major cause of mortality, morbidity, and poor quality of life. It is an area of active research. This article is aimed to give an update on recent advances in all aspects of this syndrome. Major changes occurred in drug treatment of HF with reduced ejection fraction (HFrEF). Sacubitril/valsartan is indicated as a substitute to ACEi/ARBs after PARADIGM-HF (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.73 to 0.87 for sacubitril/valsartan vs. enalapril for the primary endpoint and Wei, Lin and Weissfeld HR 0.79, 95% CI 0.71-0.89 for recurrent events). Its initiation was then shown as safe and potentially useful in studies in patients hospitalized for acute HF. More recently, DAPA-HF trial showed the beneficial effects of the sodium-glucose transporter type 2 (SGLT2) inhibitor dapaglifozin vs. placebo, added to optimal standard therapy [HR, 0.74; 95% CI, 0.65 to 0.85;0.74; 95% CI, 0.65 to 0.85 for the primary endpoint]. Trials with other SGLT 2 inhibitors and in other patients, such as those with HF with preserved ejection fraction (HFpEF) or with recent decompensation, are ongoing. Multiple studies showed the unfavourable prognostic significance of abnormalities in serum potassium levels. Potassium lowering agents may allow initiation and titration of mineralocorticoid antagonists in a larger proportion of patients. Meta-analyses suggest better outcomes with ferric carboxymaltose in patients with iron deficiency. Drugs effective in HFrEF may be useful also in HF with mid-range ejection fraction. Better diagnosis and phenotype characterization seem warranted in HF with preserved ejection fraction. These and other burning aspects of HFpEF research are summarized and reviewed in this article.A multiparametric approach is often proposed for risk stratification of HF patients. The prognostic accuracy of the metabolic exercise test data combined with cardiac and kidney indexes risk score was found as superior to the HF Survival Score and Seattle HF model risk scores in a cohort of 6112 1106 D. Tomasoni et al.

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“…Percutaneous treatment of functional mitral regurgitation may potentially broaden the indication to the correction of this abnormality in HF patients . Adamo et al .…”

Section: Treatmentmentioning

confidence: 99%

February 2019 at a glance: pathophysiology, exercise capacity, diuretics and valve disease

Metra

2019

European J of Heart Fail

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Safety and efficacy of MitraClip™ therapy in patients with severely impaired left ventricular ejection fraction: results from the German transcatheter mitral valve interventions (TRAMI) registry

Abstract: In patients with severely reduced systolic LV function undergoing MitraClip™ therapy, procedural safety, efficacy, and clinical improvement after 1 year are comparable to patients with preserved LV function.

Cited by 62 publications

References 17 publications

Predictors of rehospitalization after percutaneous edge‐to‐edge mitral valve repair by MitraClip implantation

Predictors of rehospitalization after percutaneous edge‐to‐edge mitral valve repair by MitraClip implantation

Highlights in heart failure

February 2019 at a glance: pathophysiology, exercise capacity, diuretics and valve disease

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