Handgrip strength as a marker of frailty in patients with transcatheter edge-to-edge repair: Insights from the OCEAN-mitral registry

Background: This study aims to investigate whether handgrip strength can predict all-cause mortality following transcatheter edge-to-edge repair (TEER), and whether it improves after TEER. Methods: The OCEAN-Mitral Registry includes 2077 patients who had handgrip strength test before TEER. Scores were divided into quartiles according to the handgrip strength. Additionally, 371 of them had follow-up handgrip strength test 1 year after TEER. Results: Quartile 4 (weakest) were more likely to be older, smaller, and more symptomatic due to heart failure than others as baseline characteristics. Multivariate analyses revealed that quartile 3 and 4 were independently associated with increased risk of all-cause mortality after TEER compared with quartile 1 as a referent (adjusted hazard ratio 1.58, 95 % confidence interval 1.06–2.35, p = 0.024 for quartile 3, and adjusted hazard ratio 2.40, 95 % confidence interval 1.62–3.55, P < 0.001 for quartile 4). In subanalysis, in primary MR, handgrip strength did not change in patients with successful MR reduction (MR ≤2+), whereas it significantly decreased in those without successful MR reduction (MR 3+/4+). Conversely, in secondary MR, it significantly increased in those with successful MR reduction, whereas it did not change in those without successful MR reduction. Conclusions: Weaker handgrip strength, one of the good indicators of frailty was associated with all-cause mortality following TEER. Reduction in MR was linked to improvements in frailty. This is the largest and the very first study showing that MR reduction ≤2+ after TEER would be important for improving frailty and keeping their resilience in this population. Condensed abstract: The handgrip strength test is a quick and inexpensive way to assess the weakness as a part of frailty. The OCEAN-Mitral Registry includes 2077 patients who had handgrip strength test before transcatheter edge-to-edge repair. Weaker handgrip strength was independently associated with all-cause mortality following TEER. Itis useful for predicting mortality because of its ease. Additionally, we saw the change in frailty assessed by handgrip strength after TEER, and therefore MR reduction ≤2+ after TEER would be important for improving frailty or keeping their resilience in this population.