Predictors of Transcatheter Mitral Valve Repair Quality of Life Outcomes

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In-hospital renal failure was an independent predictor for lower 30-day Kansas City Cardiomyopathy Questionnaire–Overall Summary scores.
In-hospital renal failure was an independent predictor for lower 30-day Kansas City Cardiomyopathy Questionnaire–Overall Summary scores.

Having atrial fibrillation, using home oxygen, having severe lung disease, and having a permanent pacemaker at the time of presentation are factors predictive of lower health status after transcatheter mitral valve repair (TMVR) in patients with severe mitral regurgitation, according to study results published in JAMA Cardiology.

The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was used to obtain data from 4226 patients with severe mitral regurgitation who underwent TMVR from 2013 to 2017 at 217 hospitals in the United States.

Researchers assessed the change in disease-specific health status at 30 days and 1-year post-TMVR with the 100-point Kansas City Cardiomyopathy Questionnaire–Overall Summary score (KCCQ-OS). Scores on the KCCQ-OS characterized patients as having very poor (<25 points), poor (25 to 49 points), fair (50 to 74 points), and good (≥75 points) health statuses at follow-up. Changes in the KCCQ-OS score of 5 points, 10 points, and 20 points were associated with small, moderate, and large clinical improvements, respectively.

In the overall cohort of post-TMVR survivors who completed follow-up, health status increased from a mean of 41.9 to 66.7 from before TMVR to 30 days after TMVR, respectively (mean change, 24.8 points; 95% CI, 24.0-25.6; P <.001). Scores on the KCCQ were stable up to 1-year follow-up.

Factors independently associated with a lower 30-day KCCQ-OS score in the multivariable analysis included atrial fibrillation (−2.2 points; 95% CI, −3.7 to −0.6 points; P =.01), permanent pacemaker (−2.1 points; 95% CI, −3.7 to −0.4; P =.01), severe lung disease (−3.9 points; 95% CI, −6.2 to −1.5; P =.001), home oxygen (−2.7 points; 95% CI, −4.9 to −0.4; P =.02), and lower baseline KCCQ scores (3.9 points for each 10-point increase; 95% CI, 3.6-4.2; P <.001).

While uncommon, the researchers also found in-hospital renal failure to be an independent predictor of lower 30-day KCCQ-OS scores (−7.3 points; 95% CI, −13.3 to −1.2). More than half of the initial population were alive and well at 1-year follow-up (54.2%; 95% CI, 52.2%-56.1%).

Mortality, persistently poor health status (KCCQ-OS <60 points), health status decline from baseline, and both poor health status and health status decline occurred in 23.0%, 21.9%, 5.5%, and 4.6% of patients, respectively.

Factors associated with worse health status at 1 year included having a lower baseline health status (median [interquartile range] KCCQ-OS scores at 1 year: patients who scored 0 to 25 points at baseline, 61.2 points [95% CI, 57.3-65.1]; 25 to 49 points, 69.9 points [95% CI, 67.2-72.6]; 50 to 74 points, 76.7 points [95% CI, 73.7-79.6]; 75 to 100 points, 83.4 points [95% CI, 80.1-86.6]; P <.001) and lower rates of alive and well status (patients who had KCCQ-OS scores of 0 to 25 points at baseline, 39.8%; 25 to 49 points, 53.3%; 50 to 74 points, 66.2%; 75 to 100 points, 69.9%; P <.001).

The limited follow-up of 30 days to explore factors associated with health status recovery was a concerning study limitation cited by the researchers.

Identifying patient-specific factors associated with lower post-TMVR health status may “help inform the decision process prior to TMVR may help improve patient selection as well as patient expectations for recovery, particularly if a number of risk factors for worse health status are present in an individual patient.”

Reference

Arnold SV, Li Z, Vemulapalli S, et al. Association of transcatheter mitral valve repair with quality of life outcomes at 30 days and 1 year: analysis of the Transcatheter Valve Therapy Registry [published online November 21, 2018]. JAMA Cardiol. doi:10.1001/jamacardio.2018.3359

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