Citro Rodolfo, Baldi Cesare, Lancellotti Patrizio, Silverio Angelo, Provenza Gennaro, Bellino Michele, Di Muro Michele R, Mastrogiovanni Generoso, De Rosa Roberta, Galasso Gennaro, Bossone Eduardo, Giudice Pietro, Piscione Federico
aDepartment of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy bDepartment of Cardiology, University of Liège Hospital, GIGA-Cardiovascular Sciences, Liège, Belgium cGruppo Villa Maria Care and Research, E.S. Health Science Foundation, Lugo, Romagna dDivision UTIC, Sant'Ottone Frangipane, Ariano Irpino, Avellino, Italy.
J Cardiovasc Med (Hagerstown). 2017 Sep;18(9):669-678. doi: 10.2459/JCM.0000000000000526.
The aim of this study was to assess preoperative determinants, prevalence, and prognostic impact of left ventricular (LV) reverse remodeling (LVRR) in patients with secondary mitral regurgitation (SMR), undergoing MitraClip implantation (MCi).
From March 2012 to January 2015, a total of 41 consecutive patients with moderate-to-severe SMR treated successfully with MCi were enrolled. All patients underwent clinical and echocardiographic follow-up after MCi. Global longitudinal strain (GLS) was obtained using two dimensional speckle tracking analysis. A reduction in LV end-systolic volume more than 10% compared with baseline was considered as a marker of LVRR. Patients were divided into two groups according to the presence or absence of LVRR. Cardiac events were defined as the occurrence of cardiac death, rehospitalization for worsening heart failure, and mitral valve surgery.
On univariable analysis, EuroSCORE II and GLS were associated with LVRR. On multivariable logistic regression analysis, GLS was the only independent correlate of LVRR (P = 0.004). A receiver operating characteristic curve identified a cutoff value for GLS of -9.25% (P < 0.001) associated with LVRR, with a sensitivity and specificity of 81 and 74%, respectively. New York Heart Failure Association class more than 2 after MCi, absence of LVRR after MCi, and preoperative GLS more than -9.25% were significantly correlated with adverse cardiac events at long-term follow-up. On multivariable logistic regression analysis, GLS was the only independent predictor of composite adverse cardiac events at 2-year follow-up.
A worse preoperative GLS predicts no LVRR and is associated with adverse long-term outcome after successful MCi for SMR.
本研究旨在评估接受MitraClip植入术（MCi）的继发性二尖瓣反流（SMR）患者左心室（LV）逆向重构（LVRR）的术前决定因素、发生率及预后影响。
2012年3月至2015年1月，共纳入41例成功接受MCi治疗的中重度SMR患者。所有患者在MCi术后均接受临床和超声心动图随访。采用二维斑点追踪分析获得整体纵向应变（GLS）。与基线相比，左心室收缩末期容积减少超过10%被视为LVRR的标志。根据是否存在LVRR将患者分为两组。心脏事件定义为心源性死亡、因心力衰竭恶化再次住院以及二尖瓣手术的发生。
单因素分析显示，欧洲心脏手术风险评估系统II（EuroSCORE II）和GLS与LVRR相关。多因素逻辑回归分析显示，GLS是LVRR的唯一独立相关因素（P = 0.004）。受试者工作特征曲线确定与LVRR相关的GLS截断值为-9.25%（P < 0.001），敏感性和特异性分别为81%和74%。MCi术后纽约心脏协会心功能分级超过2级、MCi术后无LVRR以及术前GLS超过-9.25%与长期随访时的不良心脏事件显著相关。多因素逻辑回归分析显示，GLS是2年随访时复合不良心脏事件的唯一独立预测因素。
术前较差的GLS预示无LVRR，并与SMR患者成功接受MCi术后的不良长期预后相关。
