经导管二尖瓣边缘到边缘修复术治疗继发性二尖瓣反流并保留左心室功能。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-11-11 DOI:10.1016/j.jcin.2024.08.031

Chetan P. Huded MD, MSc , Adnan K. Chhatriwalla MD , Miloni A. Shah MPH , Sreekanth Vemulapalli MD , Andrzej Kosinski PhD , David J. Cohen MD, MSc

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引用次数: 0

摘要

背景：继发性二尖瓣反流（sMR）和左心室射血分数（LVEF）保留患者的二尖瓣经导管边缘到边缘修补术（MTEER）疗效尚不确定：本研究旨在描述保留左心室射血分数（LVEF）的继发性二尖瓣反流（sMR）患者的 MTEER 治疗效果：方法：利用 STS/ACC TVT（胸外科医师协会-美国心脏病学会经导管瓣膜治疗）注册表，我们按照二尖瓣反流（MR）残留的严重程度，评估了 LVEF >50% 的二尖瓣反流 MTEER 的风险调整后疗效，并将这些疗效与 LVEF 为 20% 至 50%、接受 MTEER 治疗的二尖瓣反流患者进行了比较：在12,083名患者中，3,011人（24.9%）的LVEF>50%，9,072人（75.1%）的LVEF在20%至50%之间。LVEF>50%与LVEF为20%至50%的患者的技术成功率、院内并发症、1年死亡率和1年堪萨斯城心肌病问卷评分相似。LVEF >50%与LVEF为20%至50%的患者1年调整后心衰住院风险较低（调整后HR：0.81；95% CI：0.68-0.97；P = 0.02）。在 LVEF >50% 的患者中，76.0% 的残留 MR ≤ 轻度，19.0% 为中度。与≤轻度MR相比，中度残余MR与1年死亡风险增加（调整后HR：1.46；95% CI：1.01-2.10；P = 0.04）和心衰住院风险增加（调整后HR：1.82；95% CI：1.32-2.52；P < 0.001）有关。1年后，LVEF>50%的患者接受MTEER治疗后，KCCQ评分有所改善（残余MR分级≤轻度，28.7±26.8；中度MR，25.7±27.2；>中度MR，21.6±12.0；所有P均<0.05）：结论：对于sMR和LVEF保留的患者，MTEER技术成功率高，并发症发生率低，健康状况改善幅度大。

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Mitral Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation With Preserved Left Ventricular Function

Background

Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain.

Objectives

This study sought to describe outcomes of MTEER for sMR with preserved LVEF.

Methods

Using the STS/ACC TVT (Society of Thoracic Surgeons–American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%.

Results

Among 12,083 patients, LVEF was >50% in 3,011 (24.9%) and 20% to 50% in 9,072 (75.1%). Technical success, in-hospital complications, the 1-year death rate, and the 1-year Kansas City Cardiomyopathy Questionnaire score were similar in patients with LVEF >50% vs LVEF of 20% to 50%. The 1-year adjusted risk of heart failure hospitalization was lower in patients with LVEF >50% vs LVEF of 20% to 50% (adjusted HR: 0.81; 95% CI: 0.68-0.97; P = 0.02). Among patients with LVEF >50%, residual MR was ≤ mild in 76.0% and moderate in 19.0%. Compared with ≤ mild MR, moderate residual MR was associated with increased 1-year risks of death (adjusted HR: 1.46; 95% CI: 1.01-2.10; P = 0.04) and heart failure hospitalization (adjusted HR: 1.82; 95% CI: 1.32-2.52; P < 0.001). At 1 year, the KCCQ score improved in patients with LVEF >50% treated with MTEER (residual MR grade ≤ mild, 28.7 ± 26.8; moderate MR, 25.7 ± 27.2; > moderate MR, 21.6 ± 12.0; all P < 0.05).

Conclusions

In patients with sMR and preserved LVEF, MTEER was associated with a high rate of technical success, a low rate of complications, and large improvements in health status.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.