{"title":"经导管边缘对边缘修复对心脏结节病患者的影响：来自ocean -二尖瓣登记的见解","authors":"Takashi Hiruma, Mike Saji, Mamoru Nanasato, Itaru Takamisawa, Ryosuke Higuchi, Yuki Izumi, Ryo Abe, Mitsuaki Isobe, Masanori Yamamoto, Shunsuke Kubo, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Daisuke Hachinohe, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida","doi":"10.1161/JAHA.124.039243","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In patients with sarcoidosis, cardiac involvement is a crucial prognostic factor leading to severe cardiovascular events. Mitral regurgitation (MR) predisposes patients to drug-refractory heart failure; however, MR in patients with cardiac sarcoidosis (CS) has been scarcely investigated and its therapeutic approach remains unclear. This study aimed to investigate the clinical impact of transcatheter edge-to-edge repair in patients with CS.</p><p><strong>Methods: </strong>Patients with CS-related ventricular functional MR were compared with those with other nonischemic cardiomyopathies in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry in Japan.</p><p><strong>Results: </strong>Among 1240 patients with nonischemic cardiomyopathy-related ventricular functional MR, 40 (3.2%) had CS. Of these, 18 patients (45.0%) had immunosuppressive therapy. Twenty-seven patients (67.5%) were New York Heart Association function class III/IV. Patients with CS were more likely to be younger and female, had a higher prevalence of ventricular tachyarrhythmia and cardiac resynchronization therapy, and had a larger left ventricle with more severe MR than the others. At the procedure, 38 patients (95.0%) had devices placed at the central lesion. All patients with CS were successfully treated, leading to immediate improvement of cardiac output. At 1-year follow-up, 89.3% had MR ≤2+ and 40.0% had New York Heart Association function class I. Despite similar outcomes between groups, greater remnant MR and fatal arrhythmic events in those with CS may be due to inadequate reverse remodeling and ongoing left ventricle damage caused by inflammation.</p><p><strong>Conclusions: </strong>Transcatheter edge-to-edge repair is an effective heart failure treatment for patients with CS-related MR; however, the drug- and cardiac device-refractory cardiomyopathy in this population warrants careful management.</p><p><strong>Registration: </strong>URL: www.umin.ac.jp/english/; Unique Identifier: UMIN000023653.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039243"},"PeriodicalIF":5.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Transcatheter Edge-to-Edge Repair in Patients With Cardiac Sarcoidosis: Insights From the OCEAN-Mitral Registry.\",\"authors\":\"Takashi Hiruma, Mike Saji, Mamoru Nanasato, Itaru Takamisawa, Ryosuke Higuchi, Yuki Izumi, Ryo Abe, Mitsuaki Isobe, Masanori Yamamoto, Shunsuke Kubo, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Daisuke Hachinohe, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida\",\"doi\":\"10.1161/JAHA.124.039243\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In patients with sarcoidosis, cardiac involvement is a crucial prognostic factor leading to severe cardiovascular events. Mitral regurgitation (MR) predisposes patients to drug-refractory heart failure; however, MR in patients with cardiac sarcoidosis (CS) has been scarcely investigated and its therapeutic approach remains unclear. This study aimed to investigate the clinical impact of transcatheter edge-to-edge repair in patients with CS.</p><p><strong>Methods: </strong>Patients with CS-related ventricular functional MR were compared with those with other nonischemic cardiomyopathies in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry in Japan.</p><p><strong>Results: </strong>Among 1240 patients with nonischemic cardiomyopathy-related ventricular functional MR, 40 (3.2%) had CS. Of these, 18 patients (45.0%) had immunosuppressive therapy. Twenty-seven patients (67.5%) were New York Heart Association function class III/IV. Patients with CS were more likely to be younger and female, had a higher prevalence of ventricular tachyarrhythmia and cardiac resynchronization therapy, and had a larger left ventricle with more severe MR than the others. At the procedure, 38 patients (95.0%) had devices placed at the central lesion. All patients with CS were successfully treated, leading to immediate improvement of cardiac output. At 1-year follow-up, 89.3% had MR ≤2+ and 40.0% had New York Heart Association function class I. Despite similar outcomes between groups, greater remnant MR and fatal arrhythmic events in those with CS may be due to inadequate reverse remodeling and ongoing left ventricle damage caused by inflammation.</p><p><strong>Conclusions: </strong>Transcatheter edge-to-edge repair is an effective heart failure treatment for patients with CS-related MR; however, the drug- and cardiac device-refractory cardiomyopathy in this population warrants careful management.</p><p><strong>Registration: </strong>URL: www.umin.ac.jp/english/; Unique Identifier: UMIN000023653.</p>\",\"PeriodicalId\":54370,\"journal\":{\"name\":\"Journal of the American Heart Association\",\"volume\":\" \",\"pages\":\"e039243\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Heart Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/JAHA.124.039243\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.124.039243","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/27 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impact of Transcatheter Edge-to-Edge Repair in Patients With Cardiac Sarcoidosis: Insights From the OCEAN-Mitral Registry.
Background: In patients with sarcoidosis, cardiac involvement is a crucial prognostic factor leading to severe cardiovascular events. Mitral regurgitation (MR) predisposes patients to drug-refractory heart failure; however, MR in patients with cardiac sarcoidosis (CS) has been scarcely investigated and its therapeutic approach remains unclear. This study aimed to investigate the clinical impact of transcatheter edge-to-edge repair in patients with CS.
Methods: Patients with CS-related ventricular functional MR were compared with those with other nonischemic cardiomyopathies in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry in Japan.
Results: Among 1240 patients with nonischemic cardiomyopathy-related ventricular functional MR, 40 (3.2%) had CS. Of these, 18 patients (45.0%) had immunosuppressive therapy. Twenty-seven patients (67.5%) were New York Heart Association function class III/IV. Patients with CS were more likely to be younger and female, had a higher prevalence of ventricular tachyarrhythmia and cardiac resynchronization therapy, and had a larger left ventricle with more severe MR than the others. At the procedure, 38 patients (95.0%) had devices placed at the central lesion. All patients with CS were successfully treated, leading to immediate improvement of cardiac output. At 1-year follow-up, 89.3% had MR ≤2+ and 40.0% had New York Heart Association function class I. Despite similar outcomes between groups, greater remnant MR and fatal arrhythmic events in those with CS may be due to inadequate reverse remodeling and ongoing left ventricle damage caused by inflammation.
Conclusions: Transcatheter edge-to-edge repair is an effective heart failure treatment for patients with CS-related MR; however, the drug- and cardiac device-refractory cardiomyopathy in this population warrants careful management.
期刊介绍：
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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