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Pressure gradient elevations after mitral valve repair increases mortality risk in AF
Patients with pre-existing atrial fibrillation who underwent percutaneous mitral valve repair and had a mitral valve pressure gradient greater than 4 mm Hg after the procedure had an increased risk for all-cause mortality at 1 year, according to a study published in The American Journal of Cardiology.
Maximilian Spieker, MD, of the division of cardiology at Heinrich Heine University in Düsseldorf, Germany, and colleagues analyzed data from 200 patients (mean age, 75 years; 38% women) who underwent percutaneous mitral valve repair with a transcatheter device (MitraClip, Abbott). Patients were categorized by the presence (n = 112; mean age, 77 years; 46% women) or absence of pre-existing AF (n = 88; mean age, 72 years; 28% women).
A follow-up visit was conducted 1 year after percutaneous mitral valve repair, when echocardiography was performed. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints were improvements in NYHA functional class and reduction in mitral regurgitation severity.
During follow-up, all-cause mortality was 17%, with no differences in patients with or without pre-existing AF. Patients with pre-existing AF who died during follow-up had an elevation in mitral valve pressure gradient compared with surviving patients without pre-existing AF (4.8 mm Hg vs. 3.6 mm Hg; P = .01).
Those with pre-existing AF who had a mitral valve pressure gradient greater than 4 mm Hg after the procedure were less likely to survive compared with those with lower mitral valve pressure gradients (P = .011). A mitral valve pressure gradient greater than 4 mm Hg was a significant predictor of mortality in patients with pre-existing AF in multivariate and univariate analyses.
“The presented data define for the first time a high-risk population characterized by an elevated [mitral valve pressure gradient] after MitraClip and the presence of pre-existing AF,” Spieker and colleagues wrote. “Future studies may address prospectively tailored strategies in this high-risk cohort ranging from medical treatment with intensified clinical follow-up and rate control to interventional enforcement of [sinus rhythm] or long-term hemodynamic monitoring.” – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.