Impact and risk predictors of proBNP levels on long-term outcomes after transcatheter edge-to-edge repair for mitral valve regurgitation.
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP025
Submission Type:
Abstract Submission
Authors:
Aleksander Dokollari (1), Serge Sicouri (2), John Malin (2), Sandra Abramson (1), Eric M Gnall (3), Gianluca Torregrossa (4), Roberto Rodriguez (1), Scott Goldman MD (1), William A Gray (1), Basel Ramlawi (5)
Institutions:
(1) Lankenau Medical Center, Wynnewood, PA, (2) Lankenau Institute for Medical Research, Wynnewood, PA, (3) Department of Cardiology, Wynnewood, PA, (4) University of Chicago, Wynnewood, PA, (5) Lankenau Heart Institute, Wynnewood, PA
Submitting Author:
Aleksander Dokollari
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Lankenau Medical Center
Lankenau Medical Center
Co-Author(s):
Serge Sicouri
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Lankenau Institute for Medical Research
Lankenau Institute for Medical Research
John Malin
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Lankenau Institute for Medical Research
Lankenau Institute for Medical Research
Sandra Abramson
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Lankenau Medical Center
Lankenau Medical Center
Eric M Gnall
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Department of Cardiology
Department of Cardiology
Gianluca Torregrossa
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University of Chicago
University of Chicago
Roberto Rodriguez
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Lankenau Medical Center
Lankenau Medical Center
*Scott Goldman MD
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Lankenau Medical Center
Lankenau Medical Center
William A Gray
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Lankenau Medical Center
Lankenau Medical Center
*Basel Ramlawi
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Lankenau Heart Institute
Lankenau Heart Institute
Presenting Author:
Aleksander Dokollari
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Abstract:
OBJECTIVE: To identify risk predictors that interact with prohormone B-type natriuretic peptide (proBNP), and analyze their impact on long-term outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral valve regurgitation (MR).
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. Patients with proBNP ≤ 500 and ˃ 500 were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). A Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors for long-term all-cause mortality.
RESULTS: A total of 171 patients who underwent TEER were included in the study. After propensity-adjusted analysis, 90 patients were included in the proBNP ≤ 500 (low) cohort and 76 patients in the proBNP ˃ 500 cohort. Preoperatively, mean age was 79.4 vs 78.4-year-old in the low proBNP and high proBNP cohorts, respectively. Cardiogenic shock incidence was 3 (3.33%) vs 8 (10.53%) in the low and high proBNP cohorts, respectively. Intraoperatively there were no differences. Postoperatively there was a higher incidence of total ICU length of stay in the high proBNP vs low proBNP cohort (54.5 vs 18.6 hours, respectively; p˂0.0001), total LOS (6.45 vs 2.7 days, respectively; p=0.003), creatinine level (1.7 vs 1.2, respectively; p=0.0001), and warfarin use upon hospital discharge (19 (25%) vs 8 (8.9%) patients, respectively; p=0.022). Mean follow-up time was 2.2 years. All-cause death (HR 1.9 [1,2; 3,0]; p=0.009), MACCE (HR 1,8 [1,2; 2,8]; p=0.006), and cardiac mortality (HR 2,2 [1,1;4,4]; p=0.026) were higher in the proBNP ˃ 500 compared to the proBNP ≤ 500 proBNP cohort. Cardiac readmission included 30 (33.3%) patients in the low proBNP cohort and 29 (38%) patients in the high proBNP cohort. Risk predictors for all-cause mortality were pre-operative grade of MR, EF ˂50%, functional MR, and NYHA class IV.
CONCLUSIONS
Patients with a proBNP level ˃ 500 had a higher incidence of all-cause mortality, MACCE and cardiac mortality when compared to patients with a proBNP ≤ 500. Risk predictors for all-cause mortality included functional MR etiology. The study outcomes suggest that prior optimization of proBNP levels in TEER by the heart-team is crucial for good outcomes.
METHODS: All consecutive patients undergoing TEER between March 2017 and October 2021 were included in the study. Patients with proBNP ≤ 500 and ˃ 500 were compared for baseline demographics. A propensity-adjusted analysis was used to compare the two groups. Primary outcome was long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). A Multivariable Cox proportional hazards regression analysis was performed to identify independent predictors for long-term all-cause mortality.
RESULTS: A total of 171 patients who underwent TEER were included in the study. After propensity-adjusted analysis, 90 patients were included in the proBNP ≤ 500 (low) cohort and 76 patients in the proBNP ˃ 500 cohort. Preoperatively, mean age was 79.4 vs 78.4-year-old in the low proBNP and high proBNP cohorts, respectively. Cardiogenic shock incidence was 3 (3.33%) vs 8 (10.53%) in the low and high proBNP cohorts, respectively. Intraoperatively there were no differences. Postoperatively there was a higher incidence of total ICU length of stay in the high proBNP vs low proBNP cohort (54.5 vs 18.6 hours, respectively; p˂0.0001), total LOS (6.45 vs 2.7 days, respectively; p=0.003), creatinine level (1.7 vs 1.2, respectively; p=0.0001), and warfarin use upon hospital discharge (19 (25%) vs 8 (8.9%) patients, respectively; p=0.022). Mean follow-up time was 2.2 years. All-cause death (HR 1.9 [1,2; 3,0]; p=0.009), MACCE (HR 1,8 [1,2; 2,8]; p=0.006), and cardiac mortality (HR 2,2 [1,1;4,4]; p=0.026) were higher in the proBNP ˃ 500 compared to the proBNP ≤ 500 proBNP cohort. Cardiac readmission included 30 (33.3%) patients in the low proBNP cohort and 29 (38%) patients in the high proBNP cohort. Risk predictors for all-cause mortality were pre-operative grade of MR, EF ˂50%, functional MR, and NYHA class IV.
CONCLUSIONS
Patients with a proBNP level ˃ 500 had a higher incidence of all-cause mortality, MACCE and cardiac mortality when compared to patients with a proBNP ≤ 500. Risk predictors for all-cause mortality included functional MR etiology. The study outcomes suggest that prior optimization of proBNP levels in TEER by the heart-team is crucial for good outcomes.
Mitral Conclave:
Transcatheter Mitral Valve Therapies
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