Miroslav Hudec, Jaroslav Januska, Otakar Jiravsky, Roman Miklik, Martin Urban, Miloslav Dorda, Alica Cesnakova Konecna, Libor Gajdusek, Ivan Ranic, David Vician, Radim Spacek, Bogna Jiravska Godula, Libor Sknouril, Petr Kala
{"title":"M-TEER术后不久肺动脉高压动态和二尖瓣残余返流对长期预后的影响：来自前瞻性登记的见解","authors":"Miroslav Hudec, Jaroslav Januska, Otakar Jiravsky, Roman Miklik, Martin Urban, Miloslav Dorda, Alica Cesnakova Konecna, Libor Gajdusek, Ivan Ranic, David Vician, Radim Spacek, Bogna Jiravska Godula, Libor Sknouril, Petr Kala","doi":"10.1007/s00392-025-02747-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.</p><p><strong>Aims: </strong>To evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.</p><p><strong>Methods: </strong>A total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.</p><p><strong>Results: </strong>Overall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38 months, time to HFH 74 vs. 44 months, and time to composite endpoint 49 vs. 26 months, all p < 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58 months, p = 0.027; time to HFH 74 months, p = 0.004; time to composite endpoint 50 months, p = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.</p><p><strong>Conclusion: </strong>Assessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. Its combination with the post-procedural level of MR can easily identify patients at low or high risk of subsequent adverse outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of pulmonary hypertension dynamics and residual mitral regurgitation shortly after M-TEER on long-term outcomes: insights from a prospective registry.\",\"authors\":\"Miroslav Hudec, Jaroslav Januska, Otakar Jiravsky, Roman Miklik, Martin Urban, Miloslav Dorda, Alica Cesnakova Konecna, Libor Gajdusek, Ivan Ranic, David Vician, Radim Spacek, Bogna Jiravska Godula, Libor Sknouril, Petr Kala\",\"doi\":\"10.1007/s00392-025-02747-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.</p><p><strong>Aims: </strong>To evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.</p><p><strong>Methods: </strong>A total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.</p><p><strong>Results: </strong>Overall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38 months, time to HFH 74 vs. 44 months, and time to composite endpoint 49 vs. 26 months, all p < 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58 months, p = 0.027; time to HFH 74 months, p = 0.004; time to composite endpoint 50 months, p = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.</p><p><strong>Conclusion: </strong>Assessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. 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引用次数: 0
摘要
背景：肺动脉高压（PH）在接受经导管边缘到边缘二尖瓣修复术（M-TEER）的患者中经常共存。其术前严重程度被认为是一个负面的预后标志。M-TEER引起的术后PH是否也可以作为长期预后指标尚不清楚。目的：评价二尖瓣残余返流（MR）的影响及PH动态对M-TEER术后长期预后的影响。方法：对2010年至2022年间使用MitraClips进行M-TEER治疗的单中心前瞻性登记的226例患者进行分析。根据术后MR严重程度（≤2.5 vs.≥3）和PH变化（稳定/改善vs.恶化）的组合，将患者分为四个表型组。主要终点是生存期、首次心力衰竭住院时间（HFH）以及两者的综合。结果：总体而言，86.3%的患者有严重MR， 59.7%的患者有基线时的PH，而出院超声心动图M-TEER后，75.7%的患者MR≤2.5,57.5%的患者无残留PH。基线PH严重程度对预后没有显著影响，但其动态影响（稳定/改善vs恶化；中位生存期63 vs 38个月，到达HFH的时间74 vs 44个月，到达复合终点的时间49 vs 26个月）均为p结论：M-TEER后不久的PH动态评估被证明是长期预后的有价值的预测指标。它与术后MR水平的结合可以很容易地识别出患者的低风险或高风险的后续不良后果。
Impact of pulmonary hypertension dynamics and residual mitral regurgitation shortly after M-TEER on long-term outcomes: insights from a prospective registry.
Background: Pulmonary hypertension (PH) often coexists in patients undergoing transcatheter edge-to-edge mitral valve repair procedure (M-TEER). Its pre-procedural severity is considered a negative prognostic marker. Whether the post-procedural PH resulting from M-TEER can also serve as a long-term prognostic marker is unknown.
Aims: To evaluate the influence of residual mitral regurgitation (MR) and the role of PH dynamics on long-term outcome after M-TEER.
Methods: A total of 226 patients from a single-centre prospective registry who underwent M-TEER with MitraClips between 2010 and 2022 were analysed. Patients were categorised into four phenotype groups based on a combination of post-procedural MR severity (≤ 2.5 vs. ≥ 3) and change in PH (stable/improved vs. worsened). Primary endpoints were survival, time to first heart failure hospitalisation (HFH) and a composite of both.
Results: Overall, 86.3% of patients had severe MR and 59.7% had PH at baseline, while 75.7% had MR ≤ 2.5 and 57.5% had no residual PH after M-TEER on discharge echocardiography. Baseline PH severity did not significantly influence outcomes, but its dynamics did (stable/improved vs. worsening; median survival 63 vs. 38 months, time to HFH 74 vs. 44 months, and time to composite endpoint 49 vs. 26 months, all p < 0.05). Patients who achieved mild/moderate MR with stable/improved PH (81.0%) showed the best results across all endpoints (median survival 58 months, p = 0.027; time to HFH 74 months, p = 0.004; time to composite endpoint 50 months, p = 0.008). The groups with worsening PH after M-TEER had the worst outcomes, regardless of the degree of MR.
Conclusion: Assessment of pH dynamics shortly after M-TEER proved to be a valuable predictor of long-term outcome. Its combination with the post-procedural level of MR can easily identify patients at low or high risk of subsequent adverse outcomes.
期刊介绍：
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.
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