Barth Sebastian, Hautmann Martina B, Kerber Sebastian, Gietzen Frank, Reents Wilko, Zacher Michael, Halbfass Philipp, Griese Daniel P, Schieffer Bernhard, Hamm Karsten
Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany.
Department of Cardiac surgery, Cardiovascular Center, Bad Neustadt, Germany.
Catheter Cardiovasc Interv. 2017 Nov 15;90(6):1038-1045. doi: 10.1002/ccd.27159. Epub 2017 Jun 1.
This study sought to investigate whether the percutaneous mitral regurgitation (MR) reduction with the MitraClip® system in end-stage heart failure patients with a left ventricular ejection fraction (LVEF) of <20% also effects beneficial outcome or whether the underlying myogenic problem is leading and therefore of prognostic relevance.
The interventional treatment of functional mitral regurgitation (FMR) with the MitraClip system could improve the clinical and hemodynamic outcome in patients with severely impaired left ventricular function.
Between 2011 and 2016, a total of 147 patients with FMR were treated with MitraClip at our institution. The cohort was divided into two groups: LVEF ≥ 20% (N = 126) and <20% (N = 21). Follow-up assessments included exercise capacity, 6-min walk test, probrain natriuretic peptide-measurement (ProBNP), echocardiography and right heart catheterization. Only three patients with an LVEF ≥ 20% and one patient with an LVEF < 20% were lost for follow-up.
In the vast majority of patients, a reduction from severe to mild MR was demonstrated with no difference between both groups (P = 0.422). At follow-up, both subgroups experienced similar improvements in exercise capacity and hemodynamics. Patients with an LVEF < 20% were on average 5.8 years younger, while mortality rates were comparable in both groups (P = 0.760).
By careful selection, even patients in the end stage of advanced LV dysfunction as the result of the underlying myogenic problem and the additional harmful effects of the high volume loading due to the FMR can exhibit significant clinical and hemodynamic improvement after MitraClip therapy.
本研究旨在调查在左心室射血分数（LVEF）<20%的终末期心力衰竭患者中，使用MitraClip®系统经皮减少二尖瓣反流（MR）是否也能产生有益结果，或者潜在的心肌问题是否起主导作用，因此具有预后相关性。
使用MitraClip系统对功能性二尖瓣反流（FMR）进行介入治疗可改善左心室功能严重受损患者的临床和血流动力学结果。
2011年至2016年期间，我院共147例FMR患者接受了MitraClip治疗。该队列分为两组：LVEF≥20%（n = 126）和<20%（n = 21）。随访评估包括运动能力、6分钟步行试验、脑钠肽前体测量（ProBNP）、超声心动图和右心导管检查。只有3例LVEF≥20%的患者和1例LVEF<20%的患者失访。
在绝大多数患者中，均显示从重度MR降至轻度MR，两组之间无差异（P = 0.422）。随访时，两个亚组在运动能力和血流动力学方面均有相似改善。LVEF<20%的患者平均年轻5.8岁，而两组的死亡率相当（P = 0.760）。
通过仔细筛选，即使是由于潜在心肌问题导致晚期左心室功能障碍终末期的患者，以及由于FMR导致高容量负荷的额外有害影响的患者，在接受MitraClip治疗后也可表现出显著的临床和血流动力学改善。
