Classification of primary mitral regurgitation using extramitral cardiac involvement in patients undergoing transcatheter edge-to-edge repair.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-10-31 DOI:10.1002/ccd.31253

Danon Kaewkes, Alon Shechter, Vivek Patel, Ofir Koren, Keita Koseki, Tarun Chakravarty, Mamoo Nakamura, Moody Makar, Raj Makkar

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引用次数: 0

Abstract

Background: An enhanced classification of primary mitral regurgitation (PMR) based on extramitral cardiac involvement may refine patient selection and optimize the timing of transcatheter edge-to-edge repair (TEER).

Aims: This study aimed to assess the prognostic significance of a recently established classification system that characterizes the extent of extramitral cardiac damage in patients undergoing TEER for PMR.

Methods: Consecutive PMR patients who received MitraClip implantation were categorized according to the presence of extramitral cardiac damage, determined through preprocedural echocardiography. The classifications included no damage or only left ventricular dilatation (group 0), left atrial involvement (group 1), right ventricular volume/pressure overload (group 2), right ventricular failure (group 3), or left ventricular failure (group 4). Cox-proportional hazard models were used to ascertain the impact of PMR groups on the primary composite outcome of all-cause mortality or rehospitalization for heart failure (HHF) over 2 years.

Results: In a cohort of 322 eligible PMR patients undergoing TEER (median age: 83 years; 41% female) between 2013 and 2020, the following distribution emerged: group 0 (10 patients, 3%), group 1 (96 patients, 30%), group 2 (117 patients, 36%), group 3 (56 patients, 18%), and group 4 (43 patients, 13%). Kaplan-Meier analysis demonstrated a significant decline in freedom from the primary outcome as group severity increased (log-rank p = 0.030). On multivariate analysis, the degree of extramitral cardiac involvement was significantly associated with the primary outcome (HR: 1.30; 95% CI: 1.02-1.67; p = 0.043), primarily driven by HHF.

Conclusions: This innovative classification system for PMR, based on extramitral cardiac involvement, carries significant prognostic implications for clinical outcomes following TEER. Integrating this classification system into clinical decision-making could enhance risk stratification and optimize the timing of TEER in these patients.

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通过对接受经导管边缘到边缘修补术的患者进行瓣外心脏受累情况对原发性二尖瓣反流进行分类。

背景：目的：本研究旨在评估最近建立的分类系统的预后意义，该系统描述了接受经导管边缘到边缘修补术（TEER）的原发性二尖瓣反流（PMR）患者的瓣外心脏损伤程度：通过术前超声心动图检查确定是否存在瓣外心脏损伤，并根据损伤程度对接受 MitraClip 植入术的连续 PMR 患者进行分类。分类包括无损伤或仅左心室扩张（0组）、左心房受累（1组）、右心室容量/压力超负荷（2组）、右心室衰竭（3组）或左心室衰竭（4组）。采用 Cox 比例危险模型确定 PMR 组别对 2 年内全因死亡率或心衰再住院（HHF）这一主要综合结果的影响：在2013年至2020年期间接受TEER治疗的322名符合条件的PMR患者（中位年龄：83岁；41%为女性）中，出现了以下分布：第0组（10名患者，3%）、第1组（96名患者，30%）、第2组（117名患者，36%）、第3组（56名患者，18%）和第4组（43名患者，13%）。卡普兰-梅耶尔分析显示，随着组别严重程度的增加，主要结果的自由度显著下降（log-rank p = 0.030）。多变量分析显示，室外心脏受累程度与主要结局显著相关（HR：1.30；95% CI：1.02-1.67；P = 0.043），主要由 HHF 驱动：这一基于腔外心脏受累的 PMR 创新分类系统对 TEER 后的临床预后具有重要意义。将该分类系统纳入临床决策可加强风险分层，优化这些患者的 TEER 时机。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.