Centro Cardiologico Monzino IRCCS, Milan, Italy.
Centro Cardiologico Monzino IRCCS, Milan, Italy.
Int J Cardiol. 2020 Jan 15;299:228-234. doi: 10.1016/j.ijcard.2019.07.060. Epub 2019 Jul 19.
Mitral regurgitation (MR) is frequently associated with severe aortic stenosis, but its influence on outcomes after transcatheter aortic valve implantation (TAVI) remains controversial. This study sought to assess the baseline etiology and degree of MR in TAVI population, identify the predictors of MR changes and investigate the clinical and prognostic impact of baseline MR at mid and long-term follow-up.
We enrolled 572 consecutive patients who underwent TAVI. MR degree and etiology were evaluated by echocardiography at baseline and 1-year follow-up. Clinical outcomes were obtained up to 3-year follow-up.
At baseline, 168 patients (29%) had moderate-to-severe MR (MR ≥ 2). Organic MR was more frequently associated with MR ≥ 2 (MR < 2: 20%, MR ≥ 2: 43%, p < 0.001). Relevant MR had improved more in functional MR (79%) compared to organic MR (50%, p = 0.001). At the multivariate analysis, the coexistence of coronary artery disease (p = 0.026), absence of atrial fibrillation (p = 0.038) and functional etiology (p = 0.025) were predictors of MR improvement after TAVI. Patients with baseline MR ≥ 2 had a higher mortality rate than those with MR < 2 at 1-year and 3-year follow-up. Moreover, a landmark analysis starting from 1-year to 3-year follow-up, demonstrated that organic MR was associated with an increased risk of mortality throughout 3-year follow-up compared with functional MR, irrespective of MR severity.
Baseline MR ≥ 2 in TAVI patients was associated with early and late mortality rate. At 1-year, significant improvement in MR severity was observed mainly in patients with functional MR ≥ 2. Organic MR ≥ 2 had a negative impact on 3-year, but not 1-year, mortality rate.
二尖瓣反流（MR）常与严重主动脉瓣狭窄相关，但在经导管主动脉瓣植入术（TAVI）后对其结局的影响仍存在争议。本研究旨在评估 TAVI 人群中基线病因和 MR 程度，确定 MR 变化的预测因素，并在中-长期随访中探讨基线 MR 的临床和预后影响。
我们纳入了 572 例连续接受 TAVI 的患者。通过超声心动图在基线和 1 年随访时评估 MR 程度和病因。临床结局随访至 3 年。
基线时，168 例（29%）患者存在中重度 MR（MR≥2）。器质性 MR 更常与 MR≥2 相关（MR＜2：20%，MR≥2：43%，p＜0.001）。与器质性 MR 相比，功能性 MR 的相关 MR 改善更为显著（79%比 50%，p=0.001）。多变量分析显示，合并冠状动脉疾病（p=0.026）、无房颤（p=0.038）和功能性病因（p=0.025）是 TAVI 后 MR 改善的预测因素。基线时 MR≥2 的患者在 1 年和 3 年随访时的死亡率高于 MR＜2 的患者。此外，从 1 年到 3 年随访的时间标志分析显示，与功能性 MR 相比，无论 MR 严重程度如何，基线时存在器质性 MR 与整个 3 年随访期间的死亡率增加相关。
TAVI 患者基线时的 MR≥2 与早期和晚期死亡率相关。在 1 年时，主要在功能性 MR≥2 的患者中观察到 MR 严重程度的显著改善。器质性 MR≥2 对 3 年而不是 1 年的死亡率有负面影响。
