经皮二尖瓣修复术前和术后的肾功能评估。
Evaluation of renal function before and after percutaneous mitral valve repair.
作者信息
Wang Andrew, Sangli Chithra, Lim Scott, Ailawadi Gorav, Kar Saibal, Herrmann Howard C, Grayburn Paul, Foster Elyse, Weissman Neil J, Glower Donald, Feldman Ted
机构信息
From the Departments of Medicine (A.W.) and Surgery (D.G.), Duke University Medical Center, Durham, NC; Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); Departments of Medicine (S.L.) and Surgery (G.A), University of Virginia, Charlottesville; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Hospital of the University of Pennsylvania, Philadelphia (H.C.H.); Department of Cardiology, Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.G.); Department of Medicine, University of California, San Francisco (E.F.); MedStar Health Research Institute, Washington, DC (N.J.W.); and Department of Medicine, Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.).
出版信息
Circ Cardiovasc Interv. 2015 Jan;8(1). doi: 10.1161/CIRCINTERVENTIONS.113.001349.
BACKGROUND
Chronic kidney disease (CKD) is strongly related to outcome in cardiovascular diseases. The relationship between treatment of mitral regurgitation (MR) and renal function is not well described. We sought to evaluate renal function before and after mitral valve repair by the MitraClip device.
METHODS AND RESULTS
Patients with moderate-to-severe or severe (3+ or 4+, respectively) MR by core laboratory determination who underwent transcatheter mitral valve repair with the MitraClip device in multicenter, investigational trials were included in this study. Estimated glomerular filtration rate (eGFR) was evaluated before and at hospital discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight hundred fifty-four patients with baseline mean eGFR 61.5 ± 23.1 mL/min/1.73 m(2) were studied, including 438 (51.3%) with eGFR ≥ 60 mL/min/1.73 m(2) (CKD stage 1 or 2), 371 (42.6%) with eGFR 30 to 59 mL/min/1.73 m(2) (CKD stage 3), and 52 (6.1%) with eGFR < 30 mL/min/1.73 m(2) (CKD stage 4 or 5). Baseline renal dysfunction was more prevalent in older patients with a history of heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, and atrial fibrillation. Baseline eGFR was associated with 1-year survival (P < 0.001) after MitraClip repair. At 1-year follow-up, the mean change in eGFR for the overall cohort was -1.0 ± 15.1 mL/min/1.73 m(2); for patients with CKD stage 1 or 2, stage 3, or stage 4 or 5, mean change was -4.1 ± 16.6, +2.6 ± 12.4, and +4.8 ± 9.5 mL/min/1.73 m(2), respectively. Linear mixed effect modeling demonstrated a strong association between MR and eGFR, and a statistically significant improvement in eGFR in patients with CKD stage 4 or 5 associated with MR reduction to ≤ 2+ (P = 0.007).
CONCLUSIONS
Renal dysfunction is associated with lower survival in patients with severe MR even after percutaneous mitral valve repair. Reduction in MR severity by the MitraClip device is associated with improvement in renal function at 1 year in patients with baseline renal dysfunction.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifiers: NCT00209274, NCT01931956, NCT01940120.
背景
慢性肾脏病（CKD）与心血管疾病的预后密切相关。二尖瓣反流（MR）的治疗与肾功能之间的关系尚未得到充分描述。我们旨在评估使用MitraClip装置进行二尖瓣修复前后的肾功能。
方法和结果
本研究纳入了在多中心研究性试验中通过核心实验室测定为中重度或重度（分别为3+或4+）MR且接受经导管二尖瓣修复术并使用MitraClip装置的患者。在二尖瓣修复术前、出院时、术后30天、6个月和1年评估估算肾小球滤过率（eGFR）。研究了854例基线平均eGFR为61.5±23.1 mL/min/1.73 m²的患者，其中438例（51.3%）eGFR≥60 mL/min/1.73 m²（CKD 1或2期），371例（42.6%）eGFR为30至59 mL/min/1.73 m²（CKD 3期），52例（6.1%）eGFR<30 mL/min/1.73 m²（CKD 4或5期）。基线肾功能不全在有心力衰竭、冠状动脉疾病、脑血管疾病、糖尿病、高血压和房颤病史的老年患者中更为普遍。基线eGFR与MitraClip修复术后1年生存率相关（P<0.001）。在1年随访时，整个队列的eGFR平均变化为-1.0±15.1 mL/min/1.73 m²；CKD 1或2期、3期、4或5期患者的平均变化分别为-4.1±16.6、+2.6±12.4和+4.8±9.5 mL/min/1.73 m²。线性混合效应模型显示MR与eGFR之间存在强关联，且CKD 4或5期患者中MR降低至≤2+时eGFR有统计学意义的改善（P = 0.007）。
结论
即使在经皮二尖瓣修复术后，肾功能不全仍与重度MR患者的较低生存率相关。MitraClip装置使MR严重程度降低与基线肾功能不全患者1年时肾功能改善相关。
临床试验注册网址
http://www.clinicaltrials.gov。唯一标识符：NCT00209274、NCT01931956、NCT01940120。
Zotero 插件