Tayyareci Y, Dworakowski R, Kogoj P, Reiken J, Kenny C, MacCarthy P, Wendler O, Monaghan M J
Cardiology Division, Liv Hospital Ulus, Istanbul, Turkey
Department of Cardiology, King's College Hospital, London, UK.
Echo Res Pract. 2016 Sep;3(3):71-8. doi: 10.1530/ERP-16-0018. Epub 2016 Jul 25.
To assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI).
In this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months. Patients having a significant reduction of at least 30% in VC were defined as good responders (GR) and the remaining patients were defined as poor responders (PR).
After 6 months of TAVI, 27 (45%) patients were GR and 33 (55%) were PR. There was a significant decrease in 3DE-derived mitral annular diameter and area (P = 0.001), mitral valve tenting area (TA) (P = 0.05), and mitral papillary muscle dyssynchrony index (DSI) (P = 0.05) in the GR group. 3DE-derived LVESV (P = 0.016), LV mass (P = 0.001) and LV DSI, (P = 0.001) were also improved 6 months after TAVI. In addition, valvulo-arterial impedance (ZVA) was significantly higher at baseline in patients with PR (P = 0.028). 3DE-derived mitral annular area (β: 0.47, P = 0.04), mitral papillary DSI (β: -0.65, P = 0.012) and ZVA (β: 0.45, P = 0.028) were the strongest independent parameters that could predict the reduction of functional MR after TAVI.
GR patients demonstrate more regression in mitral annulus area and diameter after significant decrease in high LVEDP and trans-aortic gradients with TAVI. PR patients appear to have increased baseline ZVA, mitral valve tenting and restriction in mitral valve coaptation. These factors are important for predicting the impact of TAVI on pre-existing MR.
评估经导管主动脉瓣植入术（TAVI）后二尖瓣几何形态、左心室（LV）重构及左心室整体后负荷对二尖瓣反流（MR）的影响。
本研究中，60例行TAVI的患者在基线期、术后1个月及6个月接受三维超声心动图评估。通过检查6个月时二尖瓣反流束缩流颈（VC）的百分比变化来确定TAVI后MR的比例变化。VC至少降低30%的患者被定义为良好反应者（GR），其余患者被定义为反应不佳者（PR）。
TAVI术后6个月，27例（45%）患者为GR，33例（55%）为PR。GR组中，三维超声心动图测量的二尖瓣环直径和面积（P = 0.001）、二尖瓣瓣叶帐篷样面积（TA）（P = 0.05）及二尖瓣乳头肌不同步指数（DSI）（P = 0.05）均显著减小。TAVI术后6个月，三维超声心动图测量的左心室舒张末期容积（LVESV）（P = 0.016）、左心室质量（P = 0.001）及左心室DSI（P = 0.001）也有所改善。此外，PR患者基线时的瓣膜 - 动脉阻抗（ZVA）显著更高（P = 0.028）。三维超声心动图测量的二尖瓣环面积（β：0.４７，P = 0.04）、二尖瓣乳头肌DSI（β： - 0.65，P = 0.012）及ZVA（β：0.45，P = 0.028）是预测TAVI后功能性MR降低的最强独立参数。
GR患者在TAVI使左心室舒张末期压力和跨主动脉压差显著降低后，二尖瓣环面积和直径的缩小更为明显。PR患者似乎基线ZVA升高，二尖瓣瓣叶帐篷样改变及二尖瓣瓣叶对合受限。这些因素对于预测TAVI对既往存在的MR的影响很重要。
