Differential prognostic accuracy of right ventricular dysfunction, the Seattle heart failure model and the MAGGIC score in patients with severe mitral regurgitation undergoing the MitraClip® procedure

S Heyl; B Luu; M Wieszner; A Nikkhoo; F Seeger; K Hemmann; B Assmus; B Kaess; A M Zeiher; C Walther; S Fichtlscherer; J Honold

doi:10.1016/j.ijcha.2020.100641

Differential prognostic accuracy of right ventricular dysfunction, the Seattle heart failure model and the MAGGIC score in patients with severe mitral regurgitation undergoing the MitraClip® procedure

Int J Cardiol Heart Vasc. 2020 Oct 12:31:100641. doi: 10.1016/j.ijcha.2020.100641. eCollection 2020 Dec.

Authors

S Heyl¹, B Luu¹, M Wieszner¹, A Nikkhoo¹, F Seeger¹, K Hemmann¹, B Assmus¹, B Kaess¹, A M Zeiher¹, C Walther¹, S Fichtlscherer¹, J Honold¹

Affiliation

¹ University Hospital Frankfurt, Department of Cardiology, Germany.

Abstract

Background: MitraClip ® (MC) is an established procedure for severe mitral regurgitation (MR) in patients deemed unsuitable for surgery.Right ventricular dysfunction (RVD) is associated with a higher mortality risk. The prognostic accuracy of heart failure risk scores like the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in pts undergoing MC with or without RVD has not been investigated so far.

Methods: SHFM and MAGGIC score were calculated retrospectively. RVD was determined as tricuspid annular plane systolic excursion (TAPSE) ≤15 mm. Area under receiver operating curves (AUROC) of SHFM and MAGGIC were performed for one-year all-cause mortality after MC.

Results: N = 103 pts with MR III° (73 ± 11 years, LVEF 37 ± 17%) underwent MC with a reduction of at least I° MR. One-year mortality was 28.2%.In Kaplan-Meier analysis, one- year mortality was significantly higher in RVD-pts (34.8% vs 2.8%, p = 0.009).Area under the Receiver Operating Characteristic (AUROC) for SHFM and MAGGIC were comparable for both scores (SHFM: 0.704, MAGGIC: 0.692). In pts without RVD, SHFM displayed a higher AUROC and therefore better diagnostic accuracy (SHFM: 0.776; MAGGIC: 0.551, p < 0.05). In pts with RVD, MAGGIC and SHFM displayed comparable AUROCs.

Conclusion: RVD is an important prognostic marker in pts undergoing MC. SHFM and MAGGIC displayed adequate over-all prognostic power in these pts. Accuracy differed in pts with and without RVD, indicating higher predictive power of the SHFM score in pts without RVD.

Keywords: Functional mitral regurgitation; MAGGIC score; MitraClip; Seattle heart failure model; TAPSE.