Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
J Am Soc Echocardiogr. 2012 Oct;25(10):1099-105. doi: 10.1016/j.echo.2012.07.015. Epub 2012 Aug 14.
Successful mitral valve surgical repair, decreasing volume overload, has been shown to provide reverse left ventricular (LV) and/or left atrial remodeling in most patients. Percutaneous mitral valve repair with the MitraClip system (Abbott, Abbott Park, IL) has been associated with favorable clinical outcomes in patients with mitral regurgitation at high risk of surgery. However, specific data on left cardiac chambers reverse remodeling after such procedures are limited.
This was a prospective observational study of consecutive patients at high risk of surgery, with moderate-to-severe or severe mitral regurgitation undergoing MitraClip system implantation. Follow-up echocardiography was performed at 6 months. The evaluated parameters were the LV end-diastolic and end-systolic volume indexes, LV sphericity index, LV ejection fraction, and left atrial volume index. Reverse LV remodeling was defined as a decrease of 10% in the LV end-diastolic volume index.
The study population included 44 patients: 14 with degenerative and 30 with functional mitral regurgitation. At 6 months of follow-up, significant reductions in the median and interquartile range of the sphericity index (from 0.57 [interquartile range 0.54-0.62] to 0.54 [interquartile range 0.50-0.58]; P < .001), LV end-diastolic volume index (from 79.4 mL/m(2) [interquartile range 63.0-102.2] to 60.7 mL/m(2) [50.8-84.4]; P < .001), and LV end-systolic volume index (from 49.3 mL/m(2) [interquartile range 28.2-70.5] to 28.9 mL/m(2) [interquartile range 22.2-55.8]; P < .001) were observed. The LV ejection fraction improved significantly (from 38.0% [interquartile range 30.0-55.0%] to 46.0% [interquartile range 35.0-58.0%]; P < .001) from baseline to 6 months. Minor differences in the left atrial volume index were observed. Reverse remodeling, according to the specified definition, was observed in 77.3% of the patients.
The present study reports positive LV reshape effects after mitral valve repair with the MitraClip system, showing significant improvements in LV size and function.
成功的二尖瓣手术修复，减少容量超负荷，已被证明在大多数患者中提供左心室（LV）和/或左心房的逆向重塑。经皮二尖瓣修复术使用 MitraClip 系统（雅培，雅培公园，IL）与高手术风险的二尖瓣反流患者的有利临床结果相关。然而，关于此类手术后左心腔逆向重塑的具体数据有限。
这是一项连续患者的前瞻性观察研究，这些患者有高手术风险，伴有中重度或重度二尖瓣反流，接受 MitraClip 系统植入术。在 6 个月时进行了超声心动图随访。评估的参数是 LV 舒张末期和收缩末期容积指数、LV 球形指数、LV 射血分数和左心房容积指数。LV 逆向重塑定义为 LV 舒张末期容积指数降低 10%。
研究人群包括 44 例患者：14 例为退行性病变，30 例为功能性二尖瓣反流。在 6 个月的随访中，LV 球形指数的中位数和四分位数范围显著降低（从 0.57 [四分位距 0.54-0.62]降至 0.54 [四分位距 0.50-0.58]；P<.001），LV 舒张末期容积指数（从 79.4 mL/m2 [四分位距 63.0-102.2]降至 60.7 mL/m2 [50.8-84.4]；P<.001）和 LV 收缩末期容积指数（从 49.3 mL/m2 [四分位距 28.2-70.5]降至 28.9 mL/m2 [四分位距 22.2-55.8]；P<.001）。LV 射血分数从基线到 6 个月显著改善（从 38.0% [四分位距 30.0-55.0%]升至 46.0% [四分位距 35.0-58.0%]；P<.001）。左心房容积指数略有差异。根据指定的定义，77.3%的患者出现逆向重塑。
本研究报告了 MitraClip 系统二尖瓣修复后的 LV 重塑的积极效果，显示 LV 大小和功能的显著改善。
