Vollenbroich René, Stortecky Stefan, Praz Fabien, Lanz Jonas, Franzone Anna, Zuk Katarzyna, Heg Dik, Valgimigli Marco, O'Sullivan Crochan John, Heinisch Corinna, Roost Eva, Wenaweser Peter, Windecker Stephan, Pilgrim Thomas
Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
Am Heart J. 2017 Feb;184:71-80. doi: 10.1016/j.ahj.2016.10.015. Epub 2016 Oct 28.
Among patients undergoing transcatheter aortic valve implantation (TAVI), concomitant mitral regurgitation (MR) has been associated with adverse prognosis. We aimed to assess long-term clinical outcomes according to MR etiology.
In a single-center registry of consecutive patients undergoing TAVI, we investigated the impact of functional (FMR) vs degenerative (DMR) MR on cardiovascular (CV) mortality throughout 2years of follow-up.
Among 603 patients (mean age 82.4±5.7years, 55% female) undergoing TAVI, 149 patients had moderate or severe MR (24.7%). Functional MR and DMR were documented in 53 (36%) and 96 (64%) patients, respectively. At 2years, patients with FMR and DMR had higher rates of CV mortality (30.2% vs 32.4%) as compared with patients with no MR (14.6%; FMR vs no MR: hazard ratio [HR] 2.32, 95% CI 1.34-4.02, P=.003; DMR vs no MR: HR 2.56, 95% CI 1.66-3.96, P<.001). In adjusted analyses, DMR was associated with an increased risk of CV mortality throughout the 2-year follow-up (adjusted HR 2.21, 95% CI 1.4-3.49, P=.001) as compared with FMR (adjusted HR 1.13, 95% CI 0.59-2.18, P=.707). Relevant MR was postprocedurally significantly reduced in both the DMR and FMR groups, whereas improvement of a decreased left ventricular ejection fraction was predominantly seen in the FMR group as compared with baseline.
Patients with severe, symptomatic aortic stenosis undergoing TAVI complicated by moderate or severe MR portend impaired prognosis. Particularly, patients with DMR are at increased risk for CV mortality during long-term follow-up.
在接受经导管主动脉瓣植入术（TAVI）的患者中，合并二尖瓣反流（MR）与不良预后相关。我们旨在根据MR病因评估长期临床结局。
在一个单中心连续接受TAVI患者的注册研究中，我们调查了功能性（FMR）与退行性（DMR）MR对整个2年随访期内心血管（CV）死亡率的影响。
在603例接受TAVI的患者（平均年龄82.4±5.7岁，55%为女性）中，149例患者有中度或重度MR（24.7%）。功能性MR和DMR分别记录于53例（36%）和96例（64%）患者。在2年时，与无MR的患者相比，FMR和DMR患者的CV死亡率更高（30.2%对32.4% 对比无MR患者的14.6%；FMR对比无MR：风险比[HR] 2.32，95%可信区间1.34 - 4.02，P = 0.003；DMR对比无MR：HR 2.56，95%可信区间1.66 - 3.96，P < 0.001）。在多因素分析中，与FMR相比，DMR在整个2年随访期内与CV死亡率增加相关（校正HR 2.21，95%可信区间1.4 - 3.49，P = 0.001） （校正HR 1.13，95%可信区间0.59 - 2.18，P = 0.707）。DMR组和FMR组术后相关MR均显著降低，而与基线相比，FMR组左心室射血分数降低的改善更为明显。
接受TAVI且合并中度或重度MR的严重症状性主动脉瓣狭窄患者预后不良。特别是，DMR患者在长期随访期间CV死亡率风险增加。
