{"title":"经导管边缘对边缘修复治疗功能性二尖瓣反流合并肺动脉高压的临床效果。","authors":"Mandurino-Mirizzi Alessandro, Raone Luca, Munafò Andrea Raffaele, Gazzoli Fabrizio, Mussardo Marco, Montalto Claudio, Germinal Francesco, Ferlini Marco, Porto Italo, Colonna Giuseppe, Oreglia Jacopo, Crimi Gabriele","doi":"10.1111/eci.70130","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is frequently observed in patients with functional mitral regurgitation (FMR) and heart failure with reduced ejection fraction (HFrEF) and adversely impacts prognosis. However, limited data exist on the outcomes of transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with PH, particularly regarding hemodynamic subtypes.</p><p><strong>Methods: </strong>This multicenter, retrospective analysis included 144 HFrEF patients with moderate-to-severe or severe FMR who underwent M-TEER across four Italian centers. Baseline hemodynamic assessment was performed using right heart catheterization (RHC) in conscious patients. Procedural outcomes and clinical follow-up were evaluated at 1 year. The endpoints studied included death from any cause, heart failure hospitalization and a composite endpoint of both.</p><p><strong>Results: </strong>Among the 144 patients, 84% had PH (64% combined post- and pre-capillary-PH (Cpc-PH), 20% isolated post-capillary-PH (Ipc-PH)). Procedural success was achieved in 92%, with significant improvements in New York Heart Association (NYHA) functional class (p < .001) and echocardiographic parameters. At 1 year, the composite endpoint occurred in 30% of patients, with higher rates in PH patients compared to no PH group (34% vs. 9%, respectively, p = .039). Among PH patients, Cpc-PH patients demonstrated the worst outcomes (for the composite endpoint at 1 year Cpc-PH 37% vs. Ipc-PH 24% vs. no-PH 9%, p = .031). Multivariate analysis confirmed Cpc-PH as a significant predictor of adverse outcomes at 1 year.</p><p><strong>Conclusions: </strong>M-TEER is an effective therapeutic option for patients with HFrEF and FMR, providing significant procedural success and clinical improvements. However, patients with PH, particularly those with Cpc-PH, exhibit worse long-term clinical outcomes.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70130"},"PeriodicalIF":3.6000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical outcomes of transcatheter edge-to-edge repair in patients with functional mitral regurgitation and pulmonary hypertension.\",\"authors\":\"Mandurino-Mirizzi Alessandro, Raone Luca, Munafò Andrea Raffaele, Gazzoli Fabrizio, Mussardo Marco, Montalto Claudio, Germinal Francesco, Ferlini Marco, Porto Italo, Colonna Giuseppe, Oreglia Jacopo, Crimi Gabriele\",\"doi\":\"10.1111/eci.70130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pulmonary hypertension (PH) is frequently observed in patients with functional mitral regurgitation (FMR) and heart failure with reduced ejection fraction (HFrEF) and adversely impacts prognosis. However, limited data exist on the outcomes of transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with PH, particularly regarding hemodynamic subtypes.</p><p><strong>Methods: </strong>This multicenter, retrospective analysis included 144 HFrEF patients with moderate-to-severe or severe FMR who underwent M-TEER across four Italian centers. Baseline hemodynamic assessment was performed using right heart catheterization (RHC) in conscious patients. Procedural outcomes and clinical follow-up were evaluated at 1 year. The endpoints studied included death from any cause, heart failure hospitalization and a composite endpoint of both.</p><p><strong>Results: </strong>Among the 144 patients, 84% had PH (64% combined post- and pre-capillary-PH (Cpc-PH), 20% isolated post-capillary-PH (Ipc-PH)). Procedural success was achieved in 92%, with significant improvements in New York Heart Association (NYHA) functional class (p < .001) and echocardiographic parameters. At 1 year, the composite endpoint occurred in 30% of patients, with higher rates in PH patients compared to no PH group (34% vs. 9%, respectively, p = .039). Among PH patients, Cpc-PH patients demonstrated the worst outcomes (for the composite endpoint at 1 year Cpc-PH 37% vs. Ipc-PH 24% vs. no-PH 9%, p = .031). Multivariate analysis confirmed Cpc-PH as a significant predictor of adverse outcomes at 1 year.</p><p><strong>Conclusions: </strong>M-TEER is an effective therapeutic option for patients with HFrEF and FMR, providing significant procedural success and clinical improvements. However, patients with PH, particularly those with Cpc-PH, exhibit worse long-term clinical outcomes.</p>\",\"PeriodicalId\":12013,\"journal\":{\"name\":\"European Journal of Clinical Investigation\",\"volume\":\" \",\"pages\":\"e70130\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Clinical Investigation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/eci.70130\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Clinical Investigation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/eci.70130","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Clinical outcomes of transcatheter edge-to-edge repair in patients with functional mitral regurgitation and pulmonary hypertension.
Background: Pulmonary hypertension (PH) is frequently observed in patients with functional mitral regurgitation (FMR) and heart failure with reduced ejection fraction (HFrEF) and adversely impacts prognosis. However, limited data exist on the outcomes of transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with PH, particularly regarding hemodynamic subtypes.
Methods: This multicenter, retrospective analysis included 144 HFrEF patients with moderate-to-severe or severe FMR who underwent M-TEER across four Italian centers. Baseline hemodynamic assessment was performed using right heart catheterization (RHC) in conscious patients. Procedural outcomes and clinical follow-up were evaluated at 1 year. The endpoints studied included death from any cause, heart failure hospitalization and a composite endpoint of both.
Results: Among the 144 patients, 84% had PH (64% combined post- and pre-capillary-PH (Cpc-PH), 20% isolated post-capillary-PH (Ipc-PH)). Procedural success was achieved in 92%, with significant improvements in New York Heart Association (NYHA) functional class (p < .001) and echocardiographic parameters. At 1 year, the composite endpoint occurred in 30% of patients, with higher rates in PH patients compared to no PH group (34% vs. 9%, respectively, p = .039). Among PH patients, Cpc-PH patients demonstrated the worst outcomes (for the composite endpoint at 1 year Cpc-PH 37% vs. Ipc-PH 24% vs. no-PH 9%, p = .031). Multivariate analysis confirmed Cpc-PH as a significant predictor of adverse outcomes at 1 year.
Conclusions: M-TEER is an effective therapeutic option for patients with HFrEF and FMR, providing significant procedural success and clinical improvements. However, patients with PH, particularly those with Cpc-PH, exhibit worse long-term clinical outcomes.
期刊介绍:
EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.