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。

IF 3.6 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
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
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引用次数: 0

摘要

背景:肺动脉高压(PH)常见于功能性二尖瓣反流(FMR)和心力衰竭伴射血分数降低(HFrEF)患者,并对预后有不利影响。然而,关于PH患者经导管边缘到边缘二尖瓣修复(M-TEER)的结果,特别是关于血流动力学亚型的数据有限。方法:这项多中心、回顾性分析包括144名中重度或重度FMR的HFrEF患者,他们在意大利的四个中心接受了M-TEER治疗。在意识清醒的患者中使用右心导管(RHC)进行基线血流动力学评估。1年时评估手术结果和临床随访。研究的终点包括任何原因导致的死亡、心力衰竭住院以及两者的复合终点。结果:144例患者中,84%有PH(64%合并后和前毛细血管PH (Cpc-PH), 20%分离后毛细血管PH (Ipc-PH))。手术成功率达到92%,纽约心脏协会(NYHA)功能分级显著改善(p)。结论:M-TEER是HFrEF和FMR患者的有效治疗选择,提供了显著的手术成功率和临床改善。然而,PH患者,特别是Cpc-PH患者,表现出更差的长期临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
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.
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