Background

Hepatorenal dysfunction is a strong prognostic predictor in patients with heart failure. However, the prognostic impact of the hepatorenal dysfunction in patients undergoing transcatheter mitral valve repair (TMVR) has not been well studied.

Methods

In consecutive patients who underwent edge-to-edge TMVR at three German centers, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln [serum total bilirubin (mg/dl)] + 11.76 × ln [serum creatinine (mg/dl)] + 9.44. Patients were stratified into high (> 11) or low (≤ 11) MELD-XI score of which an incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within 2 years after TMVR was assessed.

Results

Of the 881 patients, the mean MELD-XI score was 11.0 ± 5.9, and 415 patients (47.1%) had high MELD-XI score. The MELD-XI score was correlated with male, effective regurgitant orifice area, and tricuspid regurgitation severity and inversely related to left ventricular ejection fraction. Patients with high MELD-XI score had a higher incidence of the composite outcome than those with low MELD-XI score (47.7% vs. 29.8%; p < 0.0001), and in multivariable analysis, the high MELD-XI score was an independent predictor of the composite outcome [adjusted hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.02–1.77; p = 0.04). Additionally, the MELD-XI score as a continuous variable was also an independent predictor (adjusted HR 1.02; 95% CI 1.00–1.05; p = 0.048).

Conclusions

The MELD-XI score was associated with clinical outcomes within 2 years after TMVR and can be a useful risk-stratification tool in patients undergoing TMVR.

中文翻译：

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经导管边缘对边缘二尖瓣修复术后肝肾功能的预后价值

背景

肝肾功能不全是心力衰竭患者的一个强有力的预后预测因子。然而，肝肾功能不全对经导管二尖瓣修复术（TMVR）患者预后的影响尚未得到很好的研究。

方法

在三个德国中心接受边缘到边缘 TMVR 的连续患者中，不包括国际标准化比率 (MELD-XI) 评分的终末期肝病模型计算为 5.11 × ln [血清总胆红素 (mg/dl)] + 11.76 × ln [血清肌酐 (mg/dl)] + 9.44。患者被分为高 (> 11) 或低 (≤ 11) MELD-XI 评分，其中在 TMVR 后 2 年内评估复合结局的发生率，包括全因死亡率和心力衰竭住院。

结果

在 881 名患者中，平均 MELD-XI 评分为 11.0 ± 5.9，415 名患者 (47.1%) 的 MELD-XI 评分较高。MELD-XI 评分与男性、有效反流口面积和三尖瓣反流严重程度相关，与左心室射血分数负相关。MELD-XI 评分高的患者复合结局的发生率高于 MELD-XI 评分低的患者（47.7% vs. 29.8%；p  < 0.0001），在多变量分析中，高 MELD-XI 评分是独立的复合结果的预测因子 [调整后的风险比 (HR) 1.34；95% 置信区间 (CI) 1.02–1.77；p  = 0.04)。此外，作为连续变量的 MELD-XI 评分也是一个独立预测因子（调整后的 HR 1.02；95% CI 1.00–1.05；p  = 0.048）。

结论

MELD-XI 评分与 TMVR 后 2 年内的临床结果相关，并且可以成为接受 TMVR 患者的有用风险分层工具。