Influence of the ratio of mean arterial pressure to right atrial pressure on outcome after successful percutaneous edge-to-edge repair for severe mitral valve regurgitation

Rico Osteresch; Kathrin Diehl; Patrick Dierks; Johannes Schmucker; Azza Ben Ammar; Luis Alberto Mata Marin; Andreas Fach; Christian Frerker; Ingo Eitel; Rainer Hambrecht; Harm Wienbergen

doi:10.1016/j.ijcha.2021.100903

Influence of the ratio of mean arterial pressure to right atrial pressure on outcome after successful percutaneous edge-to-edge repair for severe mitral valve regurgitation

Int J Cardiol Heart Vasc. 2021 Nov 5:37:100903. doi: 10.1016/j.ijcha.2021.100903. eCollection 2021 Dec.

Authors

Affiliations

¹ Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany.
² Lübeck University Heart Center, Medical Clinic II, Lübeck, Germany.
³ German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany.

Abstract

Background: It is important to identify further predictors of outcome after successful transcatheter mitral valve repair (TMVR), as optimal patient selection remains difficult.

Objective: The study investigates the prognostic benefit of the mean arterial pressure (MAP) to right atrial pressure (RAP) ratio (MAP/RAP ratio) after successful TMVR in patients with congestive heart failure (CHF) and severe mitral regurgitation (MR).

Method: Patients with CHF and severe MR were enrolled after successful TMVR (MR ≤ 2+ at discharge). The primary endpoint was a composite of all-cause mortality or hospitalisation for heart failure. The median follow-up time was 16 ± 9 months. Receiver Operating Characteristic (ROC) analysis was applied to assess the discriminatory power of the MAP/RAP ratio. The predictive value of the MAP/RAP ratio threshold was investigated using a Kaplan-Meier analysis. Multivariable logistic regression analysis was conducted to evaluate independent risk factors for the combined primary endpoint.

Results: 145 patients (median age 76 [69-80 years], 60.3% male) were included. ROC curve analysis showed that MAP/RAP ratio was associated with an area under the curve of 0.62 (95% confidence interval (CI) 0.53-0.71; p = 0.01). A MAP/RAP ratio threshold of 7.13 was associated with 67.4% sensitivity and 57.0% specificity for the combined primary endpoint. Event-free survival was significantly lower in the MAP/RAP ratio < 7.13 group compared to those with MAP/RAP ratio ≥ 7.13 (62.2% versus 39.4%; log-rank p = 0.022). In logistic regression analysis MAP/RAP ratio was an independent predictor for the combined primary endpoint (odds ratio 0.75; 95% CI 0.62-0.90; p = 0.002).

Conclusions: The MAP/RAP ratio is associated with an unfavorable outcome in patients undergoing successful TMVR. Therefore, this new index could improve prognostic assessment of TMVR candidates.

Keywords: CHF, congestive heart failure; Chronic heart failure; LV-EF, left ventricular ejection fraction; MAP, Mean arterial pressure; MAP/RAP ratio; Mitral regurgitation; NYHA, New York Heart Association; RAP, Mean right atrial pressure; TAPSE, tricuspid annular plane systolic excursion; TMVR, transcatheter mitral valve repair; Transcatheter mitral valve repair.