Maor Elad, Raphael Claire E, Panaich Sidakpal S, Alkhouli Mohamad, Cabalka Allison, Hagler Donald J, Pollak Peter M, Reeder Guy S, Eleid Mackram F, Rihal Charanjit S
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia.
Catheter Cardiovasc Interv. 2017 Nov 1;90(5):861-869. doi: 10.1002/ccd.27179. Epub 2017 Jul 14.
Data on the clinical utility of left atrial (LA) hemodynamic monitoring during percutaneous mitral interventions are limited.
To evaluate the association between intraprocedural LA pressures during percutaneous mitral paravalvular leak (PVL) closure and long term survival.
Patients who underwent mitral PVL repair with invasive LA pressure monitoring were divided at baseline to three tertiles based on their mean final LA pressure (<25%; 25-30%; >30% of mean systolic blood pressure). Primary outcome was all-cause mortality.
134 patients (mean age 68 ± 12 years) were studied. Over 3 year mean follow-up, 81 (38%) patients died. The cumulative probability of death at 3 years was significantly higher among patients in the highest LA pressure tertile (56 ± 8% vs. 28 ± 5%, log rank P < 0.001). More than mild residual mitral regurgitation (MR) by transesophageal echocardiography (TEE) was associated with a 2.5-fold increased risk of death and patients in the highest LA pressure tertile had 2.2-fold higher mortality (P < 0.001 and = 0.003 respectively). After adjustment for residual MR by TEE, each 10% acute procedural reduction in LA pressures was associated with a significant 9% reduced risk of death (P = 0.023). Multivariate Cox regression with adjustment for multiple predictors of death showed that patients in lower LA pressure tertiles had 59% lower mortality (P = 0.003).
Lower LA pressure following mitral PVL closure is an independent predictor of improved survival, even after adjustment for residual MR. LA pressure monitoring may be a useful tool for procedural guidance during mitral PVL closure.
经皮二尖瓣介入治疗期间左心房（LA）血流动力学监测的临床效用数据有限。
评估经皮二尖瓣瓣周漏（PVL）封堵术中LA压力与长期生存之间的关联。
接受二尖瓣PVL修复并进行有创LA压力监测的患者在基线时根据其最终平均LA压力分为三个三分位数组（<平均收缩压的25%；25%-30%；>30%）。主要结局是全因死亡率。
研究了134例患者（平均年龄68±12岁）。在平均3年的随访中，81例（38%）患者死亡。LA压力最高三分位数组患者3年时的累积死亡概率显著更高（56±8%对28±5%，对数秩检验P<0.001）。经食管超声心动图（TEE）显示存在中度以上残余二尖瓣反流（MR）与死亡风险增加2.5倍相关，LA压力最高三分位数组患者的死亡率高2.2倍（分别为P<0.001和=0.003）。在对TEE显示的残余MR进行校正后，LA压力每在术中急性降低10%，死亡风险显著降低9%（P=0.023）。对多个死亡预测因素进行校正的多变量Cox回归显示，LA压力较低三分位数组的患者死亡率低59%（P=0.003）。
二尖瓣PVL封堵术后较低的LA压力是生存改善的独立预测因素，即使在对残余MR进行校正后也是如此。LA压力监测可能是二尖瓣PVL封堵术中进行手术指导的有用工具。
