Characteristics and Outcomes of Patients Undergoing Screening for Transcatheter Mitral Valve Implantation: Results from the CHOICE-MI Registry
Bibliographic record
Abstract
All articles of this category Background: There is a considerable portion of patients with mitral regurgitation (MR) unsuitable for standard therapy as recommended by current guidelines. Transcatheter mitral valve implantation (TMVI) represents a novel therapeutic alternative for these patients. The CHOICE-MI registry is a global, retrospective study aiming to assess outcomes of MR patients evaluated for TMVI who are unsuitable for standard therapy. Method: Clinical and functional outcomes of patients after TMVI were compared with those, who screen-failed TMVI and subsequently underwent bailout transcatheter edge-to-edge repair (TEER), high-risk surgery, or continued with medical therapy (MT). The primary composite endpoint was all-cause mortality or heart failure hospitalization after 1 year. Results: Among 746 patients evaluated for TMVI (78.5 years [IQR 72.0–83.0], 45.7% female, EuroSCORE II 4.7% [IQR 2.7–9.7]), 229 (30.7%) were eligible. In contrast to TMVI-ineligible patients, patients in the TMVI group had higher estimated surgical risk, lower left ventricular (LV) and right ventricular function, more dilated ventricles and were more often treated for secondary MR. In two thirds of patients ineligible for TMVI, screen failure occurred due to small LV size, predicted risk of LV outflow tract obstruction or annular size outside the treatment range for TMVI. At 1 year, MR was eliminated (residual MR <1+) in 83.9% patients treated with TMVI, compared with 8.0% (TEER), 62.2% (surgery) and 3.7% (MT) in TMVI-ineligible patients ( p < 0.001). NYHA functional Class I/II was most evident at 1 year in the TMVI group (82.6%) compared with surgery (73.3%), TEER (56.6%) and MT (34.0%) ( p < 0.001). The primary endpoint occurred in 28.8% of the TEER group and in 39.2, 42.9, and 47.9% patients treated with TMVI, surgery or MT ( p = 0.05), respectively. Conclusion: In MR patients considered unsuitable for standard therapy, TMVI was associated with sustained MR elimination and functional improvement at 1 year. TEER and mitral valve surgery represent reasonable treatment alternatives when screen-failed from TMVI, even in patients at high risk and with suboptimal anatomy, while MT was associated with poor clinical and functional outcomes. Publication History Article published online: 03 February 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".