Should the mean left atrial pressure be the ultimate goal after TMVR?

Çilingiroğlu, Mehmet; Marmagkiolis, Konstantinos

doi:10.1002/ccd.29731

Cited by 1 publication

(1 citation statement)

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“…Finally, approximately one out of five patients were correctly reclassified following the addition of postprocedure LAP to the STS risk score. This finding highlights the importance of hemodynamic data immediately after clip implantation and expands previous reports of favorable outcomes 10 even after a minor decrease in LAP, 27,28 which as presented in Figure 3, establishes a dose-response relationship with the risk of adverse events.…”

Section: Discussionsupporting

confidence: 87%

Society of thoracic surgeons risk score and left atrial pressure for predicting clinical outcomes among transcatheter mitral edge‐to‐edge repair patients

Natanzon

Koseki

Kaewkes

et al. 2023

Cathet Cardio Intervent

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Background Limited data exist regarding the performance of the Society of Thoracic Surgeons (STS) risk score among transcatheter mitral edge‐to‐edge repair (TEER) patients. Objective Evaluate STS score accuracy, and the incremental value of post‐procedural left atrial pressure (LAP). Methods A retrospective analysis of TEER patients between 2013 and 2020. Patients were allocated into 3 groups: high (≥8% [n = 298, 31%]), intermediate (4%−8% [n = 318, 33%]), and low (<4% [n = 344, 36%]). Primary outcomes included 1‐year mortality or cardiovascular hospitalizations. Cox proportional hazards regression modeling was used to determine the hazard ratio of the primary outcome, and STS score accuracy was assessed by receiver operating characteristic. A spline curve was used to display the relationship between LAP and the primary endpoint. Continuous net reclassification improvement (NRI) was used to determine the incremental value of LAP. Results We included 960 patients, primarily elderly (79 [70−85]), with a median STS risk of 5.6 (3−9). High‐risk patients were older (83 [75−89], 81 [74−87], 72 [64−79], p < 0.001), and had more comorbidities compared to intermediate and low‐risk groups. Upon Cox regression, STS score (high vs. low: HR 2.5 [1.7−3.8]; Intermediate vs. low: HR 1.8 [1.2−2.7] and LAP HR 1.03 [1.01−1.06], p = 0.007) were associated with the outcome. C statistics analysis revealed low accuracy of the STS score (AUC‐0.61 [0.58−0.65, p < 0.001]). Continuous NRI analysis indicated an improvement in risk prediction of 17% (6.9−26.2), p < 0.001. Conclusion STS risk score has low accuracy in predicting clinical outcomes after TEER. Adding LAP measurements can improve reclassification and identify those prone to adverse outcomes.

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Section: Discussionsupporting

confidence: 87%