Cardio‐hepatic syndrome in patients undergoing mitral valve transcatheter edge‐to‐edge repair

Stolz, Lukas; Orban, Mathias; Karam, Nicole; Lubos, Edith; Wild, Mirjam; Weckbach, Ludwig; Stocker, Thomas J.; Praz, Fabien; Braun, Daniel; Löw, Kornelia; Hausleiter, Sebastian; Stark, Konstantin; Doldi, Philipp; Tence, Noemie; Orban, Martin; Higuchi, Satoshi; Haum, Magda; Windecker, Stephan; Hagl, Christian; Mayerle, Julia; Näbauer, Michael; Kalbacher, Daniel; Massberg, Steffen und Hausleiter, Jörg (2023): Cardio‐hepatic syndrome in patients undergoing mitral valve transcatheter edge‐to‐edge repair. In: European Journal of Heart Failure, Bd. 25, Nr. 6: S. 872-884

Abstract

Aims The impact of the cardio-hepatic syndrome (CHS) on outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) for relevant mitral regurgitation (MR) is unknown. The objectives of this study were three-fold: (i) to characterize the pattern of hepatic impairment, (ii) to investigate the prognostic value of CHS, and (iii) to evaluate the changes in hepatic function after M-TEER.

Methods and results Hepatic impairment was quantified by laboratory parameters of liver function. In accordance with existing literature, two types of CHS were distinguished: ischaemic type I CHS (elevation of both transaminases) and cholestatic type II CHS (elevation of two out of three parameters of hepatic cholestasis). The impact of CHS on 2-year mortality was evaluated using a Cox model. The change in hepatic function after M-TEER was assessed by laboratory testing at follow-up. We analysed 1083 patients who underwent M-TEER for relevant primary or secondary MR at four European centres between 2008 and 2019. Ischaemic type I and cholestatic type II CHS were observed in 11.1% and 23.0% of patients, respectively. Predictors for 2-year all-cause mortality differed by MR aetiology. While in primary MR cholestatic type II CHS was independently associated with 2-year mortality, ischaemic CHS type I was an independent mortality predictor in secondary MR patients. At follow-up, patients with MR reduction ≤2+ (obtained in 90.7% of patients) presented with improved parameters of hepatic function (median reduction of 0.2 mg/dl, 0.2 U/L and 21 U/L for bilirubin, alanine aminotransferase and gamma-glutamyl transferase, respectively, p < 0.01).

Conclusions The CHS is frequently observed in patients undergoing M-TEER and significantly impairs 2-year survival. Successful M-TEER may have beneficial effects on CHS.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Klinikum der LMU München > Medizinische Klinik und Poliklinik I (Kardiologie)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1388-9842
• Sprache: Englisch