Prognostic impact of vasopressor test in transcatheter edge-to-edge repair of secondary mitral regurgitation: The PETIT study.

Fecha de publicación: 03/06/2024 Fecha Ahead of Print: 01/06/2024

Autores de IIS La Fe

• José Luis Díez Gil

  Autor

Participantes ajenos a IIS La Fe

• Gonzalez-Gutierrez, Jose Carlos
• Benito-Gonzalez, Tomas
• Bosa-Ojeda, Francisco
• Freixa-Rofastes, Xavier
• Estevez-Loureiro, Rodrigo
• Pascual, Isaac
• Andraka-Ikazuriaga, Leire
• Urbano-Carrillo, Cristobal
• Amat-Santos, Ignacio J

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

Abstract

BACKGROUND: Vasopressor test (VPT) might be useful in patients with functional mitral regurgitation (MR) and left ventricular dysfunction (MITRA-FR-like patients) during transcatheter edge-to-edge repair (TEER). AIMS: We aimed to evaluate the prognostic impact of VPT. METHODS: MR treated with TEER were included in a multicenter prospective registry. VPT was used intraprocedurally in patients with left ventricular dysfunction and/or hypotension. The 1-year echocardiographic and clinical outcomes were compared according to the use of VPT. The primary endpoint was a combination of mortality+heart failure (HF) readmission at 1-year. RESULTS: A total of 1115 patients were included, mean age was 72.8±10.5 years and 30.4% were women. VPT was performed in 128 subjects (11.5%), more often in critically ill patients with biventricular dysfunction. Postprocedurally the VPT group had greater rate of MR=2+ (46.9% vs. 31.7%, p=0.003) despite greater number of devices (=2 clips, 52% vs. 40.6 p=0.008) and device repositioning or new clip in 12.5%. At 1-year, the primary endpoint occurred more often in the VPT group (27.3% vs. 16.9%, p=0.002) as well as all-cause mortality (21.9% vs. 8.1%, p=0.001) but no differences existed in HF readmission rate (14.8% vs. 13.2%, p=0.610), cardiovascular mortality (4.4% vs. 3.9%, p=0.713) or residual MR=2+ (51.1% vs 51.7%, p=0.371). CONCLUSIONS: Dynamic evaluation of MR during TEER procedure through VPT was performed in patients with worse baseline risk who also presented higher all-cause mortality at 1-year follow-up. However, 1-year residual MR, cardiovascular mortality and HF readmission rate remained comparable suggesting that VPT might help in the management of MITRA-FR-like patients.

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Keywords

• inotropic; mitral regurgitation; transcatheter edge-to-edge repair; vasopressor test