Neal M Duggal, Milo Engoren, Paul Sorajja, D Scott Lim, Jason H Rogers, Scott M Chadderdon, Firas E Zahr, Evelio Rodriguez, M Andrew Morse, Enrique Garcia-Sayan, Nishtha Sodhi, Marcella A Calfon Press, Gorav Ailawadi
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We sought to estimate the association between intraoperatively measured residual mitral regurgitation (rMR) and TMPG and 1-year mortality among patients undergoing mitral transcatheter edge-to-edge repair to facilitate decisions on additional devices.</p><p><strong>Methods: </strong>In patients with severe secondary (functional) MR, we analyzed registry data using generalized estimating equations. Both rMR and TMPG were nonlinearly transformed using fractional polynomials.</p><p><strong>Results: </strong>We studied 570 patients with secondary MR who underwent mitral transcatheter edge-to-edge repair in 11 centers. Most patients were men (61%) and averaged 72±12 years of age. Most (78%) patients had TMPG <5 mm Hg and 22% had TMPG ≥5 mm Hg. Postprocedural MR severity improved substantially, being ≤2+ in 95% (with ≤1+ in 76%), 3+ in 3%, and 4+ in 2%. 1-year mortality was 20%. After adjustment for confounders, rMR (odds ratio, 2.10 [95% CI, 1.88-2.35]; <i>P</i><0.001 for rMR<sup>.5</sup>) and TMPG remained associated with mortality, with odds ratios of 1.26 (95% CI, 1.19-1.32), 1.84 (1.58-2.10), and 3.13 (2.31-3.98) for TMPG values of 4, 6, and 8, respectively, compared with TMPG=2 mm Hg at rMR=1+.</p><p><strong>Conclusions: </strong>Both rMR and TMPG were nonlinearly associated with 1-year mortality. At low levels of rMR, changes in TMPG are associated with only small changes in the risk of death. Conversely, at higher levels of rMR, even small changes in TMPG are associated with larger changes in the absolute risk of death.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014843"},"PeriodicalIF":6.1000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Residual Mitral Regurgitation Interacts With Transmitral Mean Pressure Gradient to Modify the Association With Mortality Following Transcatheter Edge-to-Edge Repair.\",\"authors\":\"Neal M Duggal, Milo Engoren, Paul Sorajja, D Scott Lim, Jason H Rogers, Scott M Chadderdon, Firas E Zahr, Evelio Rodriguez, M Andrew Morse, Enrique Garcia-Sayan, Nishtha Sodhi, Marcella A Calfon Press, Gorav Ailawadi\",\"doi\":\"10.1161/CIRCINTERVENTIONS.124.014843\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The association, if any, between the transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair and 1-year mortality is controversial in patients undergoing mitral transcatheter edge-to-edge repair with the MitraClip system. We sought to estimate the association between intraoperatively measured residual mitral regurgitation (rMR) and TMPG and 1-year mortality among patients undergoing mitral transcatheter edge-to-edge repair to facilitate decisions on additional devices.</p><p><strong>Methods: </strong>In patients with severe secondary (functional) MR, we analyzed registry data using generalized estimating equations. Both rMR and TMPG were nonlinearly transformed using fractional polynomials.</p><p><strong>Results: </strong>We studied 570 patients with secondary MR who underwent mitral transcatheter edge-to-edge repair in 11 centers. Most patients were men (61%) and averaged 72±12 years of age. Most (78%) patients had TMPG <5 mm Hg and 22% had TMPG ≥5 mm Hg. Postprocedural MR severity improved substantially, being ≤2+ in 95% (with ≤1+ in 76%), 3+ in 3%, and 4+ in 2%. 1-year mortality was 20%. After adjustment for confounders, rMR (odds ratio, 2.10 [95% CI, 1.88-2.35]; <i>P</i><0.001 for rMR<sup>.5</sup>) and TMPG remained associated with mortality, with odds ratios of 1.26 (95% CI, 1.19-1.32), 1.84 (1.58-2.10), and 3.13 (2.31-3.98) for TMPG values of 4, 6, and 8, respectively, compared with TMPG=2 mm Hg at rMR=1+.</p><p><strong>Conclusions: </strong>Both rMR and TMPG were nonlinearly associated with 1-year mortality. At low levels of rMR, changes in TMPG are associated with only small changes in the risk of death. 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引用次数: 0
摘要
背景:在使用MitraClip系统进行二尖瓣边缘修复的患者中,二尖瓣边缘修复后的膈膜平均压力梯度(TMPG)与1年死亡率之间是否存在关联是有争议的。我们试图估计术中测量的二尖瓣残余返流(rMR)和TMPG与二尖瓣经导管边缘到边缘修复患者1年死亡率之间的关系,以方便决定是否使用其他设备。方法:在严重继发性(功能性)MR患者中,我们使用广义估计方程分析注册数据。rMR和TMPG均采用分数阶多项式进行非线性变换。结果:我们在11个中心研究了570例接受二尖瓣经导管边缘到边缘修复的继发性MR患者。大多数患者为男性(61%),平均年龄72±12岁。大多数(78%)患者有TMPG (P.5), TMPG仍与死亡率相关,与rMR=1+时TMPG=2 mm Hg相比,TMPG值为4、6和8时的比值比分别为1.26 (95% CI, 1.19-1.32)、1.84(1.58-2.10)和3.13(2.31-3.98)。结论:rMR和TMPG均与1年死亡率呈非线性相关。在低rMR水平下,TMPG的变化仅与死亡风险的微小变化相关。相反,在较高的rMR水平下,即使TMPG的微小变化也与绝对死亡风险的较大变化相关。
Residual Mitral Regurgitation Interacts With Transmitral Mean Pressure Gradient to Modify the Association With Mortality Following Transcatheter Edge-to-Edge Repair.
Background: The association, if any, between the transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair and 1-year mortality is controversial in patients undergoing mitral transcatheter edge-to-edge repair with the MitraClip system. We sought to estimate the association between intraoperatively measured residual mitral regurgitation (rMR) and TMPG and 1-year mortality among patients undergoing mitral transcatheter edge-to-edge repair to facilitate decisions on additional devices.
Methods: In patients with severe secondary (functional) MR, we analyzed registry data using generalized estimating equations. Both rMR and TMPG were nonlinearly transformed using fractional polynomials.
Results: We studied 570 patients with secondary MR who underwent mitral transcatheter edge-to-edge repair in 11 centers. Most patients were men (61%) and averaged 72±12 years of age. Most (78%) patients had TMPG <5 mm Hg and 22% had TMPG ≥5 mm Hg. Postprocedural MR severity improved substantially, being ≤2+ in 95% (with ≤1+ in 76%), 3+ in 3%, and 4+ in 2%. 1-year mortality was 20%. After adjustment for confounders, rMR (odds ratio, 2.10 [95% CI, 1.88-2.35]; P<0.001 for rMR.5) and TMPG remained associated with mortality, with odds ratios of 1.26 (95% CI, 1.19-1.32), 1.84 (1.58-2.10), and 3.13 (2.31-3.98) for TMPG values of 4, 6, and 8, respectively, compared with TMPG=2 mm Hg at rMR=1+.
Conclusions: Both rMR and TMPG were nonlinearly associated with 1-year mortality. At low levels of rMR, changes in TMPG are associated with only small changes in the risk of death. Conversely, at higher levels of rMR, even small changes in TMPG are associated with larger changes in the absolute risk of death.
期刊介绍:
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.