Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair

Volker H Schmitt; Martin Geyer; Sonja Born; Kevin Bachmann; Katharina Schnitzler; Michaela Hell; Alexander R Tamm; Tobias Friedrich Ruf; Theresa Ann Maria Gößler; Marc A Rogmann; Omar Hahad; Lukas Hobohm; Johannes Herzog; Johannes Windschmitt; Sören Schwuchow-Thonke; Recha Blessing; Eberhard Schulz; Philipp Lurz; Thomas Münzel; Karsten Keller; Ralph Stephan von Bardeleben

doi:10.1016/j.ijcha.2025.101601

Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair

Int J Cardiol Heart Vasc. 2025 Jan 25:56:101601. doi: 10.1016/j.ijcha.2025.101601. eCollection 2025 Feb.

Authors

Volker H Schmitt^{1

2}, Martin Geyer¹, Sonja Born¹, Kevin Bachmann¹, Katharina Schnitzler¹, Michaela Hell¹, Alexander R Tamm¹, Tobias Friedrich Ruf¹, Theresa Ann Maria Gößler¹, Marc A Rogmann¹, Omar Hahad^{1

2}, Lukas Hobohm¹, Johannes Herzog¹, Johannes Windschmitt¹, Sören Schwuchow-Thonke¹, Recha Blessing¹, Eberhard Schulz¹, Philipp Lurz¹, Thomas Münzel^{1

2

3}, Karsten Keller^{1

3}, Ralph Stephan von Bardeleben¹

Affiliations

¹ Department of Cardiology, Cardiology I, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.
² German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
³ Center for Thrombosis and Hemostasis (CTH), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.

Abstract

Aim: Diabetes mellitus (DM) represents a notable risk factor within surgical and interventional procedures. Data on its influence on survival after Transcatheter Edge-to-Edge Repair (TEER) of Mitral valve Regurgitation (MR) are sparse.

Methods: In a retrospective monocentric assessment after successful treatment of MR using TEER from 06/2010 to 03/2018 patients were stratified for DM. Mortality was analyzed during follow-up using Cox regression analyses.

Results: Of 627 patients (47.0 % females, 88.2 % aged ≥ 70 years, median follow-up 486 days) consecutively included, subjects with DM (N = 174, 27.8 %) had a higher prevalence of comorbidities like obesity (27.3 % vs. 9.2 %, p < 0.001), arterial hypertension (91.4 % vs. 83.7 %, p = 0.013), renal insufficiency (63.8 % vs. 43.9 %, p < 0.001), coronary artery disease (77.0 % vs. 59.8 %, p < 0.001) and peripheral artery disease (14.4 % vs. 8.4 %, p = 0.026). Patients with DM presented with higher median logistic Euroscore I (29.4 % [20.0/43.0] vs. 25.0 % [16.7/36.6], p = 0.001) and more severely reduced systolic function (LVEF 35 % [30/50] vs. 45 % [30/55], p < 0.001). No difference in short- and long-term survival was detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6 %, p = 0.771; at 30-days 5.0 vs. 6.0 %, p = 0.842, 1-year 28.7 vs. 25.0 %, p = 0.419, 3-years 49.2 vs. 44.1 %, p = 0.554, 5-years 69.0 vs. 68.3 %, p = 0.497). The presence of DM was not attributed as an individual risk factor for elevated mortality (HR 1-year 1.17 [95 % CI 0.80-1.71], p = 0.419; HR long-term 1.13 [95 %CI 0.86-1.49], p = 0.373).

Conclusion: Although linked to a more vulnerable clinical profile and despite being factored in common risk factor models, DM was not associated with an elevated short- and long-term mortality after TEER of MR.

Keywords: Diabetes mellitus; MitraClip®; Mitral valve regurgitation; Mitral valve repair; Multidisciplinary heart team; Transcatheter edge-to-edge repair.