Jansen R, Wind A M, Cramer M J, Nijhoff F, Agostoni P, Ramjankhan F Z, Suyker W J, Stella P R, Chamuleau S A J
Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Int J Cardiovasc Imaging. 2018 Aug;34(8):1193-1204. doi: 10.1007/s10554-018-1328-y. Epub 2018 Mar 10.
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.
本研究的目的是通过二维（2D）经胸超声心动图（TTE）的标准化评估以及1年的超声心动图和临床结果，评估经导管主动脉瓣置换术（TAVR）患者的二尖瓣反流（MR）严重程度。分析了2008年至2014年间接受TAVR患者的术前和术后TTE。根据当前指南采用系统和综合的方法对MR进行分级。分析了纵向超声心动图和临床结果。使用预先确定的变量和混杂因素对随访时MR分级的变化进行回归分析。213名受试者有术前和术后TTE数据。基线时22%的患者存在显著MR，随访时为15%；MR分级≥3级的患者<10%。61%的患者严重程度未改变，20%的患者严重程度降低。总体而言，TAVR前后MR分级的患病率无显著差异，也不受MR病因或TAVR假体类型的影响。然而，基线时较高的MR分级和无起搏器与TAVR后MR的更多改善独立相关。关于临床结果，无论基线MR分级如何，三分之二的患者纽约心脏协会（NYHA）心功能分级得到改善。TAVR后不同MR分级之间的总生存率无显著差异。在接受TAVR的患者中，使用系统的2D超声心动图方法进行MR分级在临床实践中是可行的。我们的数据显示，显著MR的患病率相对较高（尽管≥3级很少见），总体上在1年随访时MR分级无变化，NYHA功能分级得到改善，TAVR后不同MR分级之间长期生存率无显著差异。
