Kaneko Hidehiro, Neuss Michael, Schau Thomas, Weissenborn Jens, Butter Christian
Department of Cardiology, Heart Center Brandenburg, Bernau, Germany.
Department of Cardiology, Medical School Brandenburg, Ladeburger Straße 17, 16321, Bernau, Germany.
Heart Vessels. 2016 Dec;31(12):1988-1996. doi: 10.1007/s00380-016-0822-1. Epub 2016 Mar 11.
Left ventricular systolic dysfunction (LVD) is associated with poor outcomes after mitral regurgitation (MR) surgery. MitraClip (MC) is a novel treatment option for MR patients with a high surgical risk. However, outcomes of LVD patients underwent MC remain unclear. In total of 194 patients after MC implantation, 75 patients (39 %) had severe LVD (LV ejection fraction ≤30 %). Patients with severe LVD were primarily male and also younger. Logistic euroSCOREs were comparable between the two groups. Functional MR was more common in patients with severe LVD, while New York Heart Association (NYHA) class was similar between the two groups. N-terminal pro-B-type natriuretic peptide (NT-proBNP) was significantly higher in patients with LVD. In addition to similar improvements in MR severity, NYHA class, and NT-proBNP levels, the survival rates were not different between patients with and without severe LVD. Among patients with severe LVD, the long-term survival rates were significantly lower in patients aged ≥75 years, those with NT-proBNP >5000 pg/mL, and those with atrial fibrillation (AF). In conclusion, severe LVD was not associated with the mortality after MC implantation. MC might be feasible and effective even in the patients with severe MR and low LVEF. However, we need to carefully observe severe LVD patients who are elderly, have a high NT-proBNP level, and have AF, as these might be considered high-risk subjects.
左心室收缩功能障碍（LVD）与二尖瓣反流（MR）手术后的不良预后相关。MitraClip（MC）是一种针对手术风险高的MR患者的新型治疗选择。然而，接受MC治疗的LVD患者的预后仍不明确。在总共194例植入MC后的患者中，75例（39%）患有严重LVD（左心室射血分数≤30%）。严重LVD患者主要为男性且年龄较轻。两组之间的逻辑欧洲心脏手术风险评估系统（EuroSCORE）评分相当。功能性MR在严重LVD患者中更为常见，而两组之间的纽约心脏协会（NYHA）心功能分级相似。LVD患者的N末端B型利钠肽原（NT-proBNP）显著更高。除了在MR严重程度、NYHA心功能分级和NT-proBNP水平方面有类似改善外，有和没有严重LVD的患者生存率并无差异。在严重LVD患者中，年龄≥75岁、NT-proBNP>5000 pg/mL以及患有心房颤动（AF）的患者长期生存率显著较低。总之，严重LVD与MC植入后的死亡率无关。即使对于严重MR和低左心室射血分数（LVEF）的患者，MC可能也是可行且有效的。然而，我们需要仔细观察老年、NT-proBNP水平高且患有AF的严重LVD患者，因为这些患者可能被视为高危人群。
