Giaimo Valerio L, Zappulla Paolo, Cirasa Arianna, Tempio Donatella, Sanfilippo Maria, Rapisarda Giulia, Trovato Danilo, Grazia Angelo Di, Liotta Claudio, Grasso Carmelo, Capodanno Davide, Tamburino Corrado, Calvi Valeria
Arrhythmology OU, Ferrarotto Hospital, University of Catania, Catania, Italy.
Pacing Clin Electrophysiol. 2018 Jan;41(1):65-72. doi: 10.1111/pace.13241. Epub 2018 Jan 9.
This study deals with clinical and echocardiographic outcomes in cardiac resynchronization therapy (CRT) nonresponders patients undergoing Mitraclip procedure.
Functional mitral regurgitation (FMR) occurs in approximately one-third of heart failure (HF) patients. Resynchronization therapy may correct FMR in patients with HF; however, significant FMR persists in 20-25% of CRT patients.
All patients included were previously treated with CRT for at least 6 months and remained classified as New York Heart Association (NYHA) functional class III or IV despite optimal medical therapy; the echocardiographic assessment showed lack of decrease of the left ventricular end-systolic volume (LVESV) of at least 10% and residual moderate-to-severe or severe FMR. Clinical and echocardiographic follow-up was scheduled at 1, 3, 6, and 12 months after Mitraclip implantation, and every 6 months thereafter.
Thirty patients fulfilled inclusion criteria. Before Mitraclip implantation NYHA class was III in 83% and IV in 17% of patients; after CRT no patient experienced an improvement in FMR. There was a significant improvement in NYHA class from baseline to 6 months, which remained sustained at 12 and 24 months. The degree of FMR significantly improved from baseline to 6 months and from 6 to 12 months. There was left ventricle remodeling with significant reduction of LVESV and an increase of left ventricle ejection fraction at 6 and 12 months, while the opposite trend was noted between 12 and 24 months CONCLUSION: Treatment of moderate to severe FMR in CRT nonresponder is feasible, safe, and reasonably effective in reducing cardiac symptoms.
本研究探讨接受二尖瓣夹合术的心脏再同步治疗（CRT）无反应患者的临床和超声心动图结果。
功能性二尖瓣反流（FMR）发生在约三分之一的心力衰竭（HF）患者中。再同步治疗可能纠正HF患者的FMR；然而，20%-25%的CRT患者仍存在明显的FMR。
纳入的所有患者此前均接受CRT治疗至少6个月，尽管接受了最佳药物治疗，但仍被归类为纽约心脏协会（NYHA）功能分级III或IV级；超声心动图评估显示左心室收缩末期容积（LVESV）至少减少10%且存在中度至重度或重度FMR残留。在二尖瓣夹合术植入后1、3、6和12个月安排临床和超声心动图随访，此后每6个月进行一次。
30例患者符合纳入标准。在二尖瓣夹合术植入前，83%的患者NYHA分级为III级，17%为IV级；CRT治疗后，无患者的FMR得到改善。从基线到6个月，NYHA分级有显著改善，在12个月和24个月时仍持续。FMR程度从基线到6个月以及从6个月到12个月均有显著改善。在6个月和12个月时出现左心室重塑，LVESV显著降低，左心室射血分数增加，而在12个月和24个月之间观察到相反的趋势。结论：在CRT无反应者中治疗中度至重度FMR是可行、安全的，并且在减轻心脏症状方面相当有效。
