Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium.
Department of Cardiology, Hospital Sint-Jan Brugge, Ruddershove 10, Brugge, Belgium.
Eur Heart J Cardiovasc Imaging. 2019 Mar 1;20(3):307-313. doi: 10.1093/ehjci/jey088.
The effect of MitraClip implantation on left ventricular (LV) remodelling has been shown to be highly variable. The present study wants to assess patterns of LV remodelling and its relationship with outcome.
Serial echocardiography before, 1 and 6 months after MitraClip implantation was performed in 79 pts with severe mitral regurgitation (MR) (age 74 ± 10 years, New York Heart Association III/IV 80%, LV ejection fraction 38 ± 13%, logistic EuroSCORE 21 ± 15, and functional MR 81%). LV reverse/adverse remodelling was defined as a >15% decrease/>10% increase in LV end-diastolic volume (LVEDV), respectively. Patients were followed over a period of 32 ± 16 months with all-cause mortality as the primary endpoint. A sustained (6 month) reduction of MR ≤ 2 post-MitraClip implantation was observed in 83% of patients. The average decrease in LVEDV 6 months after intervention was 13% ± 16%. Reverse remodelling at 6 months occurred in 40 patients (51%), and adverse remodelling occurred in 6 patients (8%). Patients with adverse remodelling showed a 38% increase of LVEDV at 1 month vs. no early change in LVEDV in patients with reverse remodelling. During follow-up, a total of 25 patients (32%) died. Patients with adverse remodelling died more frequently than patients with reverse remodelling [67% vs. 27%, adjusted odds ratio of 5.6 (95% CI 1.5-21)].
The majority of patients undergoing MitraClip implantation for severe MR showed LV reverse remodelling. However, there was a small group in whom afterload mismatch resulted in sustained adverse remodelling with subsequent high mortality.
经导管二尖瓣夹合术（MitraClip）植入对左心室（LV）重构的影响具有高度变异性。本研究旨在评估 LV 重构的模式及其与结局的关系。
对 79 例严重二尖瓣反流（MR）患者（年龄 74±10 岁，纽约心脏协会 III/IV 级 80%，LV 射血分数 38±13%，逻辑欧洲心脏手术风险评分 21±15%，功能性 MR 81%）在 MitraClip 植入前、植入后 1 个月和 6 个月进行了连续超声心动图检查。LV 逆重构/不良重构定义为 LV 舒张末期容积（LVEDV）分别增加>15%/减少>10%。患者在 32±16 个月的随访期间，以全因死亡率为主要终点。83%的患者在 MitraClip 植入后 6 个月观察到持续（6 个月）MR 减少≤2。干预后 6 个月 LVEDV 的平均减少量为 13%±16%。6 个月时有 40 例（51%）患者发生逆重构，6 例（8%）患者发生不良重构。与逆重构患者相比，发生不良重构的患者在 1 个月时 LVEDV 增加了 38%，而逆重构患者的 LVEDV 没有早期变化。随访期间，共有 25 例患者（32%）死亡。发生不良重构的患者比发生逆重构的患者死亡更频繁[67%比 27%，调整后的比值比为 5.6（95%CI 1.5-21]）。
接受经导管二尖瓣夹合术治疗严重 MR 的大多数患者表现出 LV 逆重构。然而，有一小部分患者由于后负荷不匹配导致持续的不良重构，随后死亡率较高。
