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International Journal of
Clinical Cardiology ISSN: 2378-2951

Citation

Cirasa A, Popolo Rubbio A, Zappulla P, Di Grazia A, Dugo D, et al. (2019) Long-Term Clinical and Echocardiographic Outcome in Patients with CRT and Functional Mitral Regurgitation: MitraClip versus Optimal Medical Therapy. Int J Clin Cardiol 6:142. doi.org/10.23937/2378-2951/1410142

Copyright

© 2019 Cirasa A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/2378-2951/1410142

Long-Term Clinical and Echocardiographic Outcome in Patients with CRT and Functional Mitral Regurgitation: MitraClip versus Optimal Medical Therapy

Arianna Cirasa, MD*, Antonio Popolo Rubbio, MD, Paolo Zappulla, MD, Angelo Di Grazia, MD, Daniela Dugo, MD, Salvatore Scandura, MD, Sarah Mangiafico, MD, Carmelo Grasso, MD, Corrado Tamburino, MD, PhD, Davide Capodanno, MD, PhD and Valeria Calvi, MD, PhD

Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, University of Catania, Italy

Abstract

Objectives

This study sought to evaluate the clinical outcome in cardiac resynchronization therapy (CRT) patients with residual moderate-to-severe functional mitral regurgitation (FMR) who underwent percutaneous treatment with the Mitraclip System or were managed with medical therapy alone.

Background

Significant FMR can persist in 20-25% of patients after CRT and its management can be a challenge, due to the advanced heart failure (HF) and a variety of concomitant comorbidities.

Methods

From a single center, two different groups of patients with CRT (MitraClip and no-MitraClip group) were compared. Clinical follow-up was scheduled at 30-day, 12 months and 24 months in all patients. The primary endpoint was the composite of all-cause death or HF hospitalizations at 24-month follow-up.

Results

Forty patients (56%) were treated with the Mitraclip System (MitraClip group) and 31 patients (44%) only with medical therapy (no-MitraClip group). MitraClip group presented higher surgical risk than no-MitraClip group, as older age, chronic kidney disease, higher NYHA functional class and lower left ventricular ejection fraction. At 24-month no differences in all-cause mortality were detected between the two groups (Kaplan-Meier curves log-rank p = 0.947), although the MitraClip group presented lower rate of HF hospitalizations than the no-MitraClip group (log-rank p = 0.048). After adjustment for confounding factors, time to HF hospitalization or death was significantly delayed in MitraClip group (hazard ratio: 0.38; p-value 0.018).

Conclusion

In CRT patients, the treatment of moderate-to-severe FMR with the Mitraclip System - if compared to medical therapy alone - is a safe and effective approach in reducing cardiac symptoms and the rate of hospitalizations for HF.