Frontiers in cardiovascular medicine · 2022
Mortality and Clinical Predictors After Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Regression Analysis.
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Shi Wence, Zhang Wenchang, Zhang Da, Ye Guojie, Ding Chunhua
Аннотация
BACKGROUND: Percutaneous mitral valve repair (PMVR) provides an available choice for patients suffering from secondary mitral regurgitation (SMR), especially those whose symptoms persist after optimal, conventional, heart-failure therapy. However, conflicting results from clinical trials have created a problem in identifying patients who will benefit the most from PMVR.
OBJECTIVE: To pool mortality data and assess clinical predictors after PMVR among patients with SMR. To this end, subgroup and meta-regression analyses were additionally performed.
METHODS: We searched PubMed, EMBASE, and Cochrane databases, and 13 studies were finally included for meta-analysis. Estimated mortality and 95% confidence intervals (CIs) were obtained using a random-effects proportional meta-analysis. We also carried out a meta-regression analysis to clarify the potential influence of important covariates on mortality.
RESULTS: A total of 1,259 patients with SMR who had undergone PMVR were enrolled in our meta-analysis. The long-term estimated pooled mortality of PMVR was 19.3% (95% CI: 13.6-25.1). Meta-regression analysis showed that mortality was directly proportional to cardiac resynchronization therapy (CRT) (β = 0.009; 95% CI: 0.002-0.016; p = 0.009), an effective regurgitant orifice (ERO) (β = 0.009; 95% CI: 0.000-0.018; p = 0.047), and a mineralocorticoid receptor antagonist (MRA) use (β = -0.015; 95% CI: -0.023--0.006; p < 0.001). Subgroup analysis indicated that patients with preexisting AF (β = -0.002; 95% CI: -0.005- -0.000; p = 0.018) were associated with decreased mortality if they received a mitral annuloplasty device. Among the edge-to-edge repair device group, a higher left ventricular (LV) ejection fraction, or lower LV end-systolic diameter, LV end-systolic volume, and LV end-diastolic volume were proportional to lower mortality.
CONCLUSION AND RELEVANCE: The pooled mortality of PMVR was 19.3% (95% CI: 13.6-25.1). Further meta-regression indicated that AF was associated with a better outcome in conjunction with the use of a mitral annuloplasty device, while better LV functioning predicted a better outcome after the implantation of an edge-to-edge repair device.
OBJECTIVE: To pool mortality data and assess clinical predictors after PMVR among patients with SMR. To this end, subgroup and meta-regression analyses were additionally performed.
METHODS: We searched PubMed, EMBASE, and Cochrane databases, and 13 studies were finally included for meta-analysis. Estimated mortality and 95% confidence intervals (CIs) were obtained using a random-effects proportional meta-analysis. We also carried out a meta-regression analysis to clarify the potential influence of important covariates on mortality.
RESULTS: A total of 1,259 patients with SMR who had undergone PMVR were enrolled in our meta-analysis. The long-term estimated pooled mortality of PMVR was 19.3% (95% CI: 13.6-25.1). Meta-regression analysis showed that mortality was directly proportional to cardiac resynchronization therapy (CRT) (β = 0.009; 95% CI: 0.002-0.016; p = 0.009), an effective regurgitant orifice (ERO) (β = 0.009; 95% CI: 0.000-0.018; p = 0.047), and a mineralocorticoid receptor antagonist (MRA) use (β = -0.015; 95% CI: -0.023--0.006; p < 0.001). Subgroup analysis indicated that patients with preexisting AF (β = -0.002; 95% CI: -0.005- -0.000; p = 0.018) were associated with decreased mortality if they received a mitral annuloplasty device. Among the edge-to-edge repair device group, a higher left ventricular (LV) ejection fraction, or lower LV end-systolic diameter, LV end-systolic volume, and LV end-diastolic volume were proportional to lower mortality.
CONCLUSION AND RELEVANCE: The pooled mortality of PMVR was 19.3% (95% CI: 13.6-25.1). Further meta-regression indicated that AF was associated with a better outcome in conjunction with the use of a mitral annuloplasty device, while better LV functioning predicted a better outcome after the implantation of an edge-to-edge repair device.