Boerlage-vanDijk Kirsten, Wiegerinck Esther M A, Araki Motoharu, Meregalli Paola G, Bindraban Navin R, Koch Karel T, Vis M Marije, Piek Jan J, Tijssen Jan G P, Bouma Berto J, Baan Jan
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
Int J Cardiol. 2015;189:238-43. doi: 10.1016/j.ijcard.2015.01.045. Epub 2015 Jan 26.
MitraClip implantation (MCI) reduces mitral regurgitation (MR) and symptoms in patients considered inoperable or with high-surgical risk. Data to determine the benefit from MCI for an individual patient are limited. The aim of this study is to determine predictors associated with the prognosis after MCI to improve the patient selection for this procedure.
We included 84 consecutive patients (age: 76 ± 10 years, 51% male) who underwent MCI in our institution for symptomatic severe MR. All patients underwent transthoracic echocardiography before MCI; clinical and echocardiographic follow-up was obtained after MCI.
The 2-year survival was 81%. Predictors for two-year mortality in multi-variate analysis were baseline NT-proBNP ≥ 5000 μg/L (HR: 5.4, 95% CI: 1.8-16.2), previous valve surgery (HR: 4.5, 95% CI: 1.7-12.2), tricuspid regurgitation (TR)≥ grade 3 prior to MCI (HR: 2.8, 95% CI: 1.2-6.8) and absence of MR reduction after MCI (HR: 2.1, 95% CI: 1.2-3.8). The 2-year survival of patients with 0, 1 or ≥ 2 of these predictors was: 87%; 78% and 38% respectively (log-rank p < 0.001). The functional class at 1 month and mid-term follow-up was worse in patients with two or more of these predictors present at baseline compared to patients with zero or one of these predictors (1 month: p = 0.007 and mid-term: p < 0.001).
Heart failure, previous valve surgery, co-presence of TR and the degree of MR reduction after MCI are the independent predictors of survival and functional status after MCI in high risk patients. The pre-procedural characteristics may be used to optimize patient selection, while maximal MR reduction should be attempted to optimize the outcome of MCI.
二尖瓣夹合术（MCI）可减少二尖瓣反流（MR），并改善不宜手术或手术风险高的患者的症状。确定MCI对个体患者益处的数据有限。本研究旨在确定与MCI术后预后相关的预测因素，以改善该手术的患者选择。
我们纳入了84例在我院接受MCI治疗有症状的严重MR的连续患者（年龄：76±10岁，51%为男性）。所有患者在MCI术前均接受经胸超声心动图检查；MCI术后进行临床和超声心动图随访。
2年生存率为81%。多变量分析中2年死亡率的预测因素为基线NT-proBNP≥5000μg/L（HR：5.4，95%CI：1.8-16.2）、既往瓣膜手术史（HR：4.5，95%CI：1.7-12.2）、MCI术前三尖瓣反流（TR）≥3级（HR：2.8，95%CI：1.2-6.8）以及MCI术后MR未减轻（HR：2.1，95%CI：1.2-3.8）。具有0个、1个或≥2个这些预测因素的患者2年生存率分别为：87%、78%和38%（对数秩检验p<0.001）。与基线时具有零个或一个这些预测因素的患者相比，基线时具有两个或更多这些预测因素的患者在1个月和中期随访时的功能分级更差（1个月：p=0.007，中期：p<0.001）。
心力衰竭、既往瓣膜手术史、TR并存以及MCI术后MR减轻程度是高危患者MCI术后生存和功能状态的独立预测因素。术前特征可用于优化患者选择，同时应尝试最大程度减轻MR以优化MCI的结果。
