Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Impact of individual frailty domains on outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair
C. Metze1, C. Iliadis1, M. I. Körber1, A. Kalkan1, L. Ochs1, M. Brüwer1, S. Baldus1, R. Pfister1
1Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln;
Background:
Frailty is a complex multidimensional syndrome which is common in patients undergoing percutaneous mitral valve repair (PMVR) and associated with adverse outcomes. Still, there are no data available on the differential impact of individual frailty domains.

Methods:
The 5 frailty domains according to Fried (self-reported exhaustion, slowness, inactivity, weakness, unintentional weight loss) were prospectively assessed in consecutive patients undergoing PMVR. Their association with 6-week outcomes (Short Form 36 physical and mental component scores (SF-36 PCS and MCS), 6-minute walk test (6 MWT), Quality of life using Minnesota living with heart failure questionnaire (MLWHFQ)) and long-term mortality were examined.

Results:
Of 337 included patients (mean age 79 years, range 50 to 95 years, 55.2% male) 48.7% were classified as frail, 66.2% met the frailty criteria of exhaustion, 40.9% each of slowness and inactivity, 60.8% of weakness, and 42.4% of unintentional weight loss.

Procedural success (a reduction of mitral regurgitation to grade 2 or lower) and complications did not differ between patients affected and not affected by frailty domains. The length of hospital stay was longer in slow, weak (each p<0.01) and inactive (p=0.02) patients.

Clinically relevant improvement in functional tests (defined as improvement of ≥ 50 m in 6 MWT, ≥ 5 points in SF-36 and ≥ 8 points in MLWHFQ) was more pronounced in exhausted (SF-36 PCS, MLWHFQ), slow (6 MWT, MLWHFQ) and inactive (SF-36 PCS and MCS, MLWHFQ) patients.

1-year mortality was higher in exhausted, slow, weak (each p<0.01) and inactive (p=0,02) patients.

The combined endpoint of 1-year survival with symptomatic benefit (improvement of ≥ 8 points in MLWHFQ after 6 weeks) was significantly more often reached in exhausted (p<0.01) and inactive (p=0.03) patients.

The hazard ratio for death during a median long-term follow-up time of 517 days was significantly higher for exhausted, slow, weak, and inactive patients. Exhaustion and slowness remained a significant influencing factor after adjustment for NT-proBNP levels, NYHA-class, and age.

Conclusion:
With respect to the presence of different frailty domains, PMVR was equally safe and successful. Individual frailty domains showed differently graded and partly opposite associations with symptomatic benefit and mortality. Nonetheless, patients with any frailty domain had at least the same rate of 1-year survival with early symptomatic benefit as patients without the respective domain, supporting the use of PMVR in the broad range of frail patients.

 

Exhaustion

Slowness

Inactivity

Weakness

Δ 6 MWT ≥ 50m after 6 weeks

41% vs. 33.7%

p=0.26

47.2% vs. 33.3%

p=0.03

39.4% vs. 37.7%

p=0.79

39% vs. 37.5%

p=0.81

Δ SF PCS ≥ 5 points after 6 weeks

62.8% vs. 42.1%

p<0.01

61.2% vs. 52.6%

p=0.16

63.4% vs. 50.6%

p=0.04

55% vs. 56.8%

p=0.77

Δ SF MCS ≥ 5 points after 6 weeks

33,9% vs. 26,3%

p=0.2

34% vs. 29.7%

p=0.46

38.4% vs. 26.5%

p=0.04

33.1% vs. 28.8%

p=0.44

Δ MLWHFQ ≥ 8 points after 6 weeks

66.1% vs. 41.1%

p<0.01

68.3% vs. 51.4%

p<0.01

69.4% vs. 49.7%

p<0.01

57.5% vs. 57.6%

p=0.98

1-year mortality

20.6% vs. 5.3%

p<0.01

 

26.8% vs. 7.5%

p<0.01

21% vs. 11.6%

p=0.02

20.5% vs. 7.6%

p<0.01

1-year survival with early symptomatic benefit  

59% vs. 40%

p<0.01

58.4% vs. 49.2%

p=0.14

60.4% vs. 47.3%

p=0.03

50.6% vs. 55.1%

p=0.46

Death (HR, 95% CI) after median follow-up-time of 517 days

2.68 (1.53-4.71)

2.74 (1.74-4.3)

1.96 (1.26-3.05)

1.83 (1.12-2.96)

 
https://dgk.org/kongress_programme/jt2022/aP1568.html