Abstract 121 Impact of transcatheter edge-to-edge mitral valve repair on sleep-disordered breathing

Sleep-disordered breathing (SDB) and its subtype central sleep apnea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Pharmacological and device therapy of heart failure have been shown to ameliorate SDB. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of SDB in patients with symptomatic mitral regurgitation.

We enrolled 47 patients with symptomatic moderate-to-severe or severe mitral regurgitation undergoing TEER in a prospective single-center study. Mean age was 72±12 years, 41% of the patients were of female gender. Secondary mitral regurgitation was present in 79% of patients, 68% of patients exhibited reduced left ventricular ejection fraction (<50%). Respiratory polygraphy was performed in the night before TEER in a compensated state and four weeks after the procedure in an ambulatory setting. 34 patients completed the follow-up. Reduction of mitral regurgitation to mild or mild-to-moderate was achieved in 85% of patients. At baseline, 56% of patients showed moderate-to-severe SDB, of whom 68% were classified as CSA. Four weeks after TEER, both Apnea-Hypopnea index and Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7-30] vs. 7 [4-15] /h, p=0.007; 6 [0-34] vs. 0 [0-8] %, p=0.008). Median relative reduction of central apnea index was 75% (p=0.023), while obstructive apnea index did not change significantly (p=0.153). Higher systolic pulmonary artery pressure at baseline independently predicted a significant reduction (>50%) of both Apnea-hypopnea index and Cheyne-Stokes respiration (odds ratio per mmHg 1.14, 95% CI 1.01-1.29, p=0.038 and 1.21, 95% CI 1.03-1.43, p=0.024), suggesting pulmonary decongestion as the mechanism behind CSA amelioration.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Impact of transcatheter edge-to-edge mitral valve repair on sleep-disordered breathing
M. Paulus¹, T. Liedtke¹, C. Meindl¹, M. Hamerle¹, C. Schach¹, L. S. Maier¹, S. Stadler¹, C. Birner², K. Debl¹, M. Arzt¹, B. Unsöld¹
¹Klinik und Poliklinik für Innere Med. II, Kardiologie, Universitätsklinikum Regensburg, Regensburg; ²Klinik für Innere Medizin I, Klinikum St. Marien, Amberg;
Aims Sleep-disordered breathing (SDB) and its subtype central sleep apnea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Pharmacological and device therapy of heart failure have been shown to ameliorate SDB. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of SDB in patients with symptomatic mitral regurgitation. Methods and results We enrolled 47 patients with symptomatic moderate-to-severe or severe mitral regurgitation undergoing TEER in a prospective single-center study. Mean age was 72±12 years, 41% of the patients were of female gender. Secondary mitral regurgitation was present in 79% of patients, 68% of patients exhibited reduced left ventricular ejection fraction (<50%). Respiratory polygraphy was performed in the night before TEER in a compensated state and four weeks after the procedure in an ambulatory setting. 34 patients completed the follow-up. Reduction of mitral regurgitation to mild or mild-to-moderate was achieved in 85% of patients. At baseline, 56% of patients showed moderate-to-severe SDB, of whom 68% were classified as CSA. Four weeks after TEER, both Apnea-Hypopnea index and Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7-30] vs. 7 [4-15] /h, p=0.007; 6 [0-34] vs. 0 [0-8] %, p=0.008). Median relative reduction of central apnea index was 75% (p=0.023), while obstructive apnea index did not change significantly (p=0.153). Higher systolic pulmonary artery pressure at baseline independently predicted a significant reduction (>50%) of both Apnea-hypopnea index and Cheyne-Stokes respiration (odds ratio per mmHg 1.14, 95% CI 1.01-1.29, p=0.038 and 1.21, 95% CI 1.03-1.43, p=0.024), suggesting pulmonary decongestion as the mechanism behind CSA amelioration. Conclusion Treatment of mitral regurgitation by TEER is associated with a strong short-term reduction of CSA and Cheyne-Stokes respiration in high-risk patients, strengthening its value as an effective treatment option for advanced heart failure.
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