Competing Risks of Cardiac and Noncardiac Mortality in Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

IF 5.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-10-09 DOI:10.1161/JAHA.124.040496

Luca Esposito, Marco Di Maio, Cesare Baldi, Emilio Di Lorenzo, Michele Bellino, Angelo Silverio, Marianna Adamo, Arturo Giordano, Francesco De Felice, Carmelo Grasso, Antonio Popolo Rubbio, Paolo Denti, Cosmo Godino, Federico De Marco, Fausto Castriota, Ida Monteforte, Annalisa Mongiardo, Anna Sonia Petronio, Gabriele Crimi, Diego Maffeo, Antonio L Bartorelli, Rodolfo Citro, Gennaro Galasso, Giuseppe Tarantini, Giovanni Esposito, Corrado Tamburino, Francesco Bedogni

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引用次数: 0

Abstract

Background: The relative impact of cardiac and noncardiac mortality in patients with secondary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER) has been poorly investigated. We aimed to assess the competing risks and independent predictors of cardiac and noncardiac mortality in a real-world secondary mitral regurgitation population treated with M-TEER and included in the GIOTTO (Italian Society of Interventional Cardiology [GIse] Registry Of Transcatheter Treatment of Mitral Valve Regurgitation) registry.

Methods: Competing risks analysis was used to assess the cumulative incidence of cardiac and noncardiac mortality. Cox regression identified independent predictors of each outcome. Co-primary outcomes were cardiac and noncardiac death at 2 years.

Results: The analysis included 1185 consecutive patients with secondary mitral regurgitation treated with M-TEER between January 2016 and March 2020 (median age 74 years). Two-year cumulative incidences of cardiac and noncardiac mortality were 19% and 12%, respectively. At multivariable analysis, predictors of cardiac mortality were age (hazard ratio [HR], 1.03; P=0.002), New York Heart Association class (HR, 1.44; P=0.018), previous hospitalization for heart failure (HR, 1.67; P=0.016), hemoglobin (HR, 0.89; P=0.016), left ventricular end-diastolic diameter (HR, 1.02; P=0.025), left ventricular ejection fraction (HR, 0.98; P=0.022), and daily furosemide dose (HR, 1.19; P=0.003). Predictors of noncardiac mortality were New York Heart Association class (HR, 1.70; P=0.03), estimated glomerular filtration rate (HR, 0.98; P=0.002), and smoking habit (HR, 1.82; P=0.009).

Conclusions: Patients with secondary mitral regurgitation treated with M-TEER show a high 2-year incidence of both cardiac and noncardiac mortality. Understanding competing risks of mortality may improve patient selection for M-TEER.

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经导管边缘对边缘修复继发性二尖瓣返流患者心脏和非心脏死亡的竞争风险。

背景：二尖瓣瓣经导管边缘到边缘修复术（M-TEER）对继发性二尖瓣返流患者心脏和非心脏死亡率的相对影响研究甚少。我们的目的是评估现实世界中接受M-TEER治疗的继发性二尖瓣反流人群的心脏和非心脏死亡率的竞争风险和独立预测因素，并纳入GIOTTO（意大利介入心脏病学会[GIse]经导管治疗二尖瓣反流登记）登记册。方法：采用竞争风险分析评估心脏和非心脏死亡的累积发生率。Cox回归确定了每个结果的独立预测因子。共同主要结局是2年时心脏和非心脏死亡。结果：该分析纳入了2016年1月至2020年3月期间连续1185例接受M-TEER治疗的继发性二尖瓣反流患者（中位年龄74岁）。心脏和非心脏的两年累积死亡率分别为19%和12%。在多变量分析中，心脏死亡率的预测因子为年龄（危险比[HR]， 1.03； P=0.002）、纽约心脏协会分级（HR, 1.44； P=0.018）、既往心力衰竭住院（HR, 1.67； P=0.016）、血红蛋白（HR, 0.89； P=0.016）、左心室舒张末期内径（HR, 1.02； P=0.025）、左心室射血分数（HR, 0.98； P=0.022）和每日速尿剂量（HR, 1.19； P=0.003）。非心源性死亡率的预测因子为纽约心脏协会分级（HR, 1.70； P=0.03）、估计肾小球滤过率（HR, 0.98； P=0.002）和吸烟习惯（HR, 1.82； P=0.009）。结论：接受M-TEER治疗的继发性二尖瓣反流患者2年的心脏和非心脏死亡率均较高。了解相互竞争的死亡风险可以改善患者对M-TEER的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.