Background

Multiple organ dysfunction, including kidney and liver, is associated with impaired clinical outcome in patients with heart failure. The Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score has been reported as a predictor of adverse events in liver and heart disease. In the present study, we aimed to investigate the prognostic value of MELD-XI score in patients undergoing transcatheter tricuspid valve repair (TTVR).

Methods

A total of consecutive 132 patients who underwent TTVR for symptomatic tricuspid regurgitation (TR) between June 2015 and May 2020 were retrospectively analyzed. The MELD-XI score was calculated using creatinine and total-bilirubin at baseline as follows: 5.11 × ln(Total Bilirubin) + 11.76 × ln(Creatinine) + 9.44. We investigated the association between MELD-XI score and composite outcome, comprising death and heart failure hospitalization within 2 years after TTVR. The median follow-up period was 7.0 months (interquartile range [IQR]: 3.3 months to 15.4 months).

Results

In the total cohort of 132 patients [mean age 77.1 ± 7.7; Logistic European System for Cardiac Operative Risk Evaluation score 16.2% (IQR: 8.7% to 27.6%)] a successful procedure with TR reduction of at least one grade was achieved in 122 patients (92.4%). Mean MELD-XI score was 11.5 ± 5.5, and in receiver-operating characteristics curve (ROC) analysis, MELD-XI score had a higher predictive value of composite outcome within 1 year (AUC = 0.70, p=0.002) compared to creatinine, bilirubin, and estimated glomerular filtration rate. According to the results of the ROC analysis, the cut-off value of MELD-XI score was set to 14.0. The patients with a high MELD-XI score (n=39) had a higher rate of prior history of coronary artery disease, higher NT-proBNP level, and larger right ventricular diameter than those with a low MELD-XI score (n=93). The other echocardiographic and procedural findings were comparable between the two groups.

At the 2-year follow-up, 16 patients (12.1%) died and 40 patients (32.3%) experienced composite outcomes. Kaplan-Meier curve demonstrated that the high MELD-XI score was associated with a higher incidence of 2-year adverse clinical events after TTVR (Figure). In multivariable Cox-proportional hazard models, MELD-XI score was a significant predictor of the composite outcome (Hazard ratio [HR] 2.97, 95% CI, 1.58 – 5.64, p = 0.001), followed by prior history of coronary artery disease (HR 2.11, 95% CI 1.04 – 4.62, p=0.04) and procedure failure (HR 3.76, 95% CI 1.21 – 9.68, p=0.02).
 

Conclusion
The MELD-XI score was associated with an impaired clinical outcome within 2 years after TTVR, and can be useful to predict adverse outcome after TTVR.