Artificial intelligence-derived risk score for mortality in secondary mitral regurgitation treated by transcatheter edge-to-edge repair: The EuroSMR risk score

Autores da FMUP

• Francisco Pedro Morais Dias De Almeida Sampaio

  Autor

Participantes de fora da FMUP

• Hausleiter J.
• Lachmann M.
• Stolz L.
• Bedogni F.
• Rubbio A.P.
• Estèvez-Loureiro R.
• Raposeiras-Roubin S.
• Boekstegers P.
• Karam N.
• Rudolph V.
• Stocker T.
• Orban M.
• Braun D.
• Näbauer M.
• Massberg S.
• Popescu A.
• Ruf T.
• Von Bardeleben R.S.
• Iliadis C.
• Pfister R.
• Baldus S.
• Besler C.
• Kister T.
• Kresoja K.
• Lurz P.
• Thiele H.
• Koell B.
• Schofer N.
• Kalbacher D.
• Neuss M.
• Butter C.
• Laugwitz K.-L.
• Trenkwalder T.
• Xhepa E.
• Joner M.
• Omran H.
• Fortmeier V.
• Gerçek M.
• Beucher H.
• Schmitz T.
• Bufe A.
• Rothe J.
• Seyfarth M.
• Schmidt T.
• Frerker C.
• Rottländer D.
• Horn P.
• Spieker M.
• Zweck E.
• Kassar M.
• Praz F.
• Windecker S.
• Puscas T.
• Adamo M.
• Lupi L.
• Metra M.
• Villa E.
• Zoccai G.B.
• Tamburino C.
• Grasso C.
• Catriota F.
• Testa L.
• Tusa M.
• Godino C.
• Galasso M.
• Montorfano M.
• Agricola E.
• Denti P.
• De Marco F.
• Tarantini G.
• Masiero G.
• Crimi G.
• Munafò A.R.
• Giannini C.
• Petronio A.
• Pidello S.
• Boretto P.
• Montefusco A.
• Frea S.
• Angelini F.
• Bocchino P.P.
• De Felice F.
• Citro R.
• Caneiro-Queija B.
• Freixa X.
• Regueiro A.
• Sanchís L.
• Sabatè M.
• Arzamendi D.
• Asmarats L.
• Peregrina E.F.
• Benito-González T.
• Fernández-Vázquez F.
• Pascual I.
• Avanzas P.
• Nombela-Franco L.
• Tirado-Conte G.
• Pozo E.
• Portolès-Hernández A.
• Palomero V.M.
• Melica B.
• Rodes-Cabau J.
• Paradis J.-M.
• Alperi A.
• Shuvy M.
• Haberman D.

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background and Aims: Risk stratification for mitral valve transcatheter edge-to-edge repair (M-TEER) is paramount in the decision-making process to appropriately select patients with severe secondary mitral regurgitation (SMR). This study sought to develop and validate an artificial intelligence-derived risk score (EuroSMR score) to predict 1-year outcomes (survival or survival + clinical improvement) in patients with SMR undergoing M-TEER. Methods: An artificial intelligence-derived risk score was developed from the EuroSMR cohort (4172 and 428 patients treated with M-TEER in the derivation and validation cohorts, respectively). The EuroSMR score was validated and compared with established risk models. Results: The EuroSMR risk score, which is based on 18 clinical, echocardiographic, laboratory, and medication parameters, allowed for an improved discrimination of surviving and non-surviving patients (hazard ratio 4.3, 95% confidence interval 3.7-5.0; P <. 001), and outperformed established risk scores in the validation cohort. Prediction for 1-year mortality (area under the curve: 0.789, 95% confidence interval 0.737-0.842) ranged from <5% to >70%, including the identification of an extreme-risk population (2.6% of the entire cohort), which had a very high probability for not surviving beyond 1 year (hazard ratio 6.5, 95% confidence interval 3.0-14; P <. 001). The top 5% of patients with the highest EuroSMR risk scores showed event rates of 72.7% for mortality and 83.2% for mortality or lack of clinical improvement at 1-year follow-up. Conclusions: The EuroSMR risk score may allow for improved prognostication in heart failure patients with severe SMR, who are considered for a M-TEER procedure. The score is expected to facilitate the shared decision-making process with heart team members and patients. © 2024 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.

Keywords

• Artificial Intelligence; Echocardiography; Heart; Heart Valve Prosthesis Implantation; Humans; Mitral Valve Insufficiency; Risk Factors; Treatment Outcome; beta adrenergic receptor blocking agent; brain natriuretic peptide; enkephalinase inhibitor; mineralocorticoid antagonist; aged; area under the curve; Article; artificial intelligence; atrial fibrillation; body mass; cardiac resynchronization therapy; chronic obstructive lung disease; cohort analysis; coronary artery disease; echocardiography; estimated glomerular filtration rate; EuroSCORE; female; follow up; heart failure; heart left ventricle ejection fraction; heart left ventricle enddiastolic volume; hospital mortality; hospitalization; human; major clinical study; male; mitral valve regurgitation; mortality; New York Heart Association class; receiver operating characteristic; renin angiotensin aldosterone system; retrospective study; transcatheter edge to edge mitral valve repair; tricuspid annular plane systolic excursion; ar