Impact of heart failure hospitalizations on clinical outcomes after mitral transcatheter edge‐to‐edge repair: Results from the EXPAND study

• Published in: European journal of heart failure Vol. 26; no. 7; pp. 1495 - 1503
• Main Authors: Kessler, Mirjam, Rottbauer, Wolfgang, Bardeleben, Ralph Stephan, Grasso, Carmelo, Lurz, Philipp, Mahoney, Paul, Price, Matthew, Williams, Mathew, Denti, Paolo, Estevez‐Loureiro, Rodrigo, Kar, Saibal, Maisano, Francesco
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01.07.2024
• Subjects: Aged; Aged, 80 and over; Cardiac Catheterization - methods; Echocardiography - methods; Female; Follow-Up Studies; Heart Failure - physiopathology; Heart Failure - surgery; Heart Failure - therapy; Heart failure hospitalization; Heart Valve Prosthesis Implantation - methods; Hospitalization - statistics & numerical data; Humans; Male; Mitral regurgitation; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mitral valve repair; Severity of Illness Index; Transcatheter edge‐to‐edge repair; Treatment Outcome; Mitral regurgitation; Mitral valve repair; Heart failure hospitalization; Transcatheter edge‐to‐edge repair
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1002/ejhf.3250

Aim This analysis aimed to compare the clinical outcomes associated with heart failure (HF) readmissions and to identify associations with HF hospitalizations (HFH) in patients treated with the MitraClip™ NTR/XTR System in the EXPAND study. Methods and results The global, real‐world EXPAND study enrolled 1041 patients with primary or secondary mitral regurgitation (MR) treated with the MitraClip NTR/XTR System. Echocardiograms were analysed by an independent echocardiographic core laboratory. The study population was stratified into HFH and No‐HFH groups based on the occurrence of HFH 1 year post‐index procedure. Clinical outcomes including MR severity, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and all‐cause mortality were compared (HFH: n = 181; No‐HFH: n = 860). Both groups achieved consistent 1‐year MR reduction to ≤1+ (HFH vs. No‐HFH: 87.3% vs. 89.5%, p = 0.6) and significant 1‐year improvement in KCCQ scores (+16.5 vs. +22.3, p = 0.09) and NYHA functional class. However, more patients in the No‐HFH group had 1‐year NYHA class ≤II (HFH vs. No‐HFH: 67.9% vs. 81.9%, p < 0.01). All‐cause mortality at 1 year was 36.8% in the HFH group versus 10.4% in the No‐HFH group (p < 0.001). The HFH rate decreased by 63% at 1 year post‐M‐TEER versus 1 year pre‐treatment (relative risk 0.4, p < 0.001). Independent HFH associations were MR ≥2+ at discharge, HFH 1 year prior to treatment, baseline NYHA class ≥III, baseline tricuspid regurgitation ≥2+, and baseline left ventricular ejection fraction ≤40%. Conclusions This study reports the impact of HFH on clinical outcomes post‐treatment in the EXPAND study. Results demonstrate that the occurrence of HFH was associated with worse 1‐year survival, and treatment with the MitraClip system substantially reduced HFH and improved patient symptoms and quality of life. In the EXPAND study, subjects with prior HFH had an increased incidence of all‐cause mortality at 1 year. Associations with 1‐year HFH after mitral transcatheter edge‐to‐edge repair included residual MR ≥2+ at discharge, HFH in the year prior to treatment with the MitraClip system, baseline NYHA class ≥III, baseline TR ≥2+, and baseline LVEF ≤40%. CI, confidence interval; HFH, heart failure hospitalization; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; NYHA, New York Heart Association; OR, odds ratio; TR, tricuspid regurgitation.