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Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis
BACKGROUND: There is little evidence about the prognostic role of mitral regurgitation (MR) in patients with low‐flow, low‐gradient aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the prevalence and outcome implications of MR severity in...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547324/ https://www.ncbi.nlm.nih.gov/pubmed/37646211 http://dx.doi.org/10.1161/JAHA.123.029553 |
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author | Ferruzzi, Germano Junior Silverio, Angelo Giordano, Arturo Corcione, Nicola Bellino, Michele Attisano, Tiziana Baldi, Cesare Morello, Alberto Biondi‐Zoccai, Giuseppe Citro, Rodolfo Vecchione, Carmine Galasso, Gennaro |
author_facet | Ferruzzi, Germano Junior Silverio, Angelo Giordano, Arturo Corcione, Nicola Bellino, Michele Attisano, Tiziana Baldi, Cesare Morello, Alberto Biondi‐Zoccai, Giuseppe Citro, Rodolfo Vecchione, Carmine Galasso, Gennaro |
author_sort | Ferruzzi, Germano Junior |
collection | PubMed |
description | BACKGROUND: There is little evidence about the prognostic role of mitral regurgitation (MR) in patients with low‐flow, low‐gradient aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the prevalence and outcome implications of MR severity in patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR, and to evaluate whether MR improvement after TAVR could influence clinical outcome. METHODS AND RESULTS: This study included consecutive patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR at 2 Italian high‐volume centers. The study population was categorized according to the baseline MR severity and to the presence of MR improvement at discharge. The primary outcome was the composite of all‐cause death and hospitalization for worsening heart failure up to 1 year. The study included 268 patients; 57 (21%) patients showed MR >2+. Patients with MR >2+ showed a lower 1‐year survival free from the primary outcome (P<0.001), all‐cause death (P<0.001), and heart failure hospitalization (P<0.001) compared with patients with MR ≤2+. At multivariable analysis, baseline MR >2+ was an independent predictor of the primary outcome (P<0.001). Among patients with baseline MR >2+, MR improvement was reported in 24 (44%) cases after TAVR. The persistence of MR was associated with a significantly reduced survival free from the primary outcome, all‐cause death, and heart failure hospitalization up to 1 year. CONCLUSIONS: In this study, the presence of moderately severe to severe MR in patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR portends a worse clinical outcome at 1 year. TAVR may improve MR severity in nearly half of the patients, resulting in a potential outcome benefit after discharge. |
format | Online Article Text |
id | pubmed-10547324 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105473242023-10-04 Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis Ferruzzi, Germano Junior Silverio, Angelo Giordano, Arturo Corcione, Nicola Bellino, Michele Attisano, Tiziana Baldi, Cesare Morello, Alberto Biondi‐Zoccai, Giuseppe Citro, Rodolfo Vecchione, Carmine Galasso, Gennaro J Am Heart Assoc Original Research BACKGROUND: There is little evidence about the prognostic role of mitral regurgitation (MR) in patients with low‐flow, low‐gradient aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). The aim of this study was to assess the prevalence and outcome implications of MR severity in patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR, and to evaluate whether MR improvement after TAVR could influence clinical outcome. METHODS AND RESULTS: This study included consecutive patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR at 2 Italian high‐volume centers. The study population was categorized according to the baseline MR severity and to the presence of MR improvement at discharge. The primary outcome was the composite of all‐cause death and hospitalization for worsening heart failure up to 1 year. The study included 268 patients; 57 (21%) patients showed MR >2+. Patients with MR >2+ showed a lower 1‐year survival free from the primary outcome (P<0.001), all‐cause death (P<0.001), and heart failure hospitalization (P<0.001) compared with patients with MR ≤2+. At multivariable analysis, baseline MR >2+ was an independent predictor of the primary outcome (P<0.001). Among patients with baseline MR >2+, MR improvement was reported in 24 (44%) cases after TAVR. The persistence of MR was associated with a significantly reduced survival free from the primary outcome, all‐cause death, and heart failure hospitalization up to 1 year. CONCLUSIONS: In this study, the presence of moderately severe to severe MR in patients with low‐flow, low‐gradient aortic stenosis undergoing TAVR portends a worse clinical outcome at 1 year. TAVR may improve MR severity in nearly half of the patients, resulting in a potential outcome benefit after discharge. John Wiley and Sons Inc. 2023-08-30 /pmc/articles/PMC10547324/ /pubmed/37646211 http://dx.doi.org/10.1161/JAHA.123.029553 Text en © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Ferruzzi, Germano Junior Silverio, Angelo Giordano, Arturo Corcione, Nicola Bellino, Michele Attisano, Tiziana Baldi, Cesare Morello, Alberto Biondi‐Zoccai, Giuseppe Citro, Rodolfo Vecchione, Carmine Galasso, Gennaro Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title | Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title_full | Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title_fullStr | Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title_full_unstemmed | Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title_short | Prognostic Impact of Mitral Regurgitation Before and After Transcatheter Aortic Valve Replacement in Patients With Severe Low‐Flow, Low‐Gradient Aortic Stenosis |
title_sort | prognostic impact of mitral regurgitation before and after transcatheter aortic valve replacement in patients with severe low‐flow, low‐gradient aortic stenosis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547324/ https://www.ncbi.nlm.nih.gov/pubmed/37646211 http://dx.doi.org/10.1161/JAHA.123.029553 |
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