Maor Elad, Raphael Claire E, Panaich Sidakpal S, Reeder Guy S, Nishimura Rick A, Nkomo Vuyisile T, Rihal Charanjit S, Eleid Mackram F
From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Circ Cardiovasc Interv. 2017 Apr;10(4). doi: 10.1161/CIRCINTERVENTIONS.116.004856.
Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT).
Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234-394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1-6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6-19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19-47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (=0.05).
Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.
关于在二尖瓣夹合术（MitraClip）过程中左心房（LA）血流动力学监测的临床应用数据有限。本研究评估了二尖瓣夹合术后LA压力的术中变化与6分钟步行试验（6MWT）记录的运动能力改善之间的关联。
研究人群包括2014年6月至2016年7月期间在梅奥诊所（明尼苏达州罗切斯特）接受二尖瓣夹合术且完成了基线和30天随访6MWT的50例患者。当前分析的主要结局定义为6MWT改善超过中位数。研究人群的平均年龄为79±10岁，34例（68%）为男性。术前基线6MWT距离为308米（四分位间距[IQR]，234 - 394米）。二尖瓣夹合术后LA压力的急性术中变化为3毫米汞柱（IQR，1 - 6毫米汞柱），V波变化为11毫米汞柱（IQR，6 - 19毫米汞柱）。6MWT改善的中位数为25米（IQR，19 - 47米）。单因素分析显示，术后二尖瓣反流≤轻度的患者6MWT改善的可能性高4倍（=0.02）。多变量模型表明，V波每降低5毫米汞柱与6分钟步行改善可能性增加49%相关（=0.04）。以V波变化作为二分变量的类似模型显示，V波降低≥11毫米汞柱的患者6MWT改善的可能性高3.8倍（=0.05）。
二尖瓣夹合术后LA压力的急性变化与6MWT测量的临床改善相关。持续LA压力监测可能是经导管二尖瓣修复术中用于手术指导的有用工具。
