1. EuroSMR
  2. EuroSMR Risk Score

EuroSMR Risk Score

The EuroSMR Risk Score is an artificial-intelligence derived risk score which predicts one-year outcomes in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER). It was developed and validated using a large cohort of more than 4600 M-TEER patients and includes 18 clinical, echocardiographic, laboratory and medication parameters.

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NT-proBNP: N-terminal pro hormone of brain natriuretic peptide (pg/ml)

NYHA: New York Hear Association functional class 

  • I: No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs
  • II: Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity
  • III: Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances
  • IV: Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients

Hemoglobin: Baseline hemoglobin levels (g/dl)

TAPSE: Tricuspid annular plane systolic excursion (mm)

  • Measured by M-mode with the cursor optimally aligned along the direction of the tricuspid lateral annulus in the apical four-chamber view

Age: Age at the time of M-TEER (years)

eGFR: Estimated glomerular filtration rate (ml/min)

RA Area: Right atrial area (cm2)

  • Assessed in an apical four chamber view at end-systole

sPAP: Systolic pulmonary artery pressure (mmHg)

  • Echocardiographically assessed by addition of estimated RA pressure and maximum systolic tricuspid pressure gradient
  • Inferior vena cava (IVC) diameter < 2.1cm that collapses >50% with a sniff suggests normal RA pressure of 3 mmHg, whereas IVC diameter > 2.1cm that collapses < 50% with a sniff suggests high RA pressure of 15 mmHg

LVEDV: Left ventricular end-diastolic volume (ml)

  • Assessed by Simpsons biplane method
  • Volume measurements are usually based on tracings of the blood- tissue interface in the apical four- and two- chamber views. At the mitral valve level, the contour is closed by connecting the two opposite sections of the mitral ring with a straight line. LV length is defined as the distance between the middle of this line and the most distant point of the LV contour.

TR grade: TR severity grade using a four grade scale

  • 0+: None
  • 1+: Mild
  • 2+: Moderate
  • 3+: Severe
  • 4+: Massive/Torrential

Diabetes Mellitus: Either dietary treated, on oral anti diabetics or insulin dependent

RVmid diameter: Mid-ventricular diameter of the right ventricle (mm)

  • Diameter of the right ventricle at a mid-ventricular level at end-diastole

MR EROA: Mitral regurgitation effective regurgitant orifice area (cm2)

  • As derived from the proximal isovelocity surface area method

BMI: Body mass index (kg/cm2)

LA volume: Left atrial volume (ml)

  • Assessed by a biplane approach at end-systole

LVEF: Left ventricular ejection fraction (%)

  • As derived from Simpsons Biplane method

Triple GDMT: Application of a triple guideline directed medical treatment

  • Application of renin-angiotensin system inhibitors, mineralocorticoid-receptor antagonists, and beta blockers

COPD: Chronic obstructive pulmonary disease