Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Department of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
Buckinghamshire NHS Trust, Buckinghamshire, United Kingdom; Department of Medicine, Unit of Cardiology, Karolinska Institutet, 171 76 Stockholm, Sweden.
Int J Cardiol. 2019 Nov 1;294:32-36. doi: 10.1016/j.ijcard.2019.07.075. Epub 2019 Jul 24.
The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR.
The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7 days after TAVR were analyzed.
1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01-1.65, p = 0.04). Using persistent ≤mild MR as the reference, when moderate/severe MR persisted or if MR worsened from ≤mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17-2.34, p = 0.04; adjusted HR 1.97, CI 1.29-3.00, p = 0.002, respectively). If baseline moderate/severe MR improved to ≤mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75-1.58, p = 0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17-0.94; p = 0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27-3.39, p = 0.004), self-expanding valve (OR 3.8, 95% CI: 2.08-7.14, p < 0.0001), and PVL (4.3, 95% CI 2.32-7.78. p < 0.0001) were associated with MR worsening.
Moderate/severe baseline MR in patients undergoing TAVR is associated with a mortality increase during 5 years of follow-up. This risk is offset if MR improves to ≤mild, whereas worsening of MR after TAVR is associated with a 2-fold mortality increase.
经导管主动脉瓣置换术（TAVR）后二尖瓣反流（MR）变化的影响尚不清楚。我们研究了基线 MR 及 TAVR 后早期 MR 变化对 TAVR 后生存的影响。
SWEDEHEART 注册研究纳入了在瑞典进行的所有 TAVR。患者分为无/轻度 MR 和中/重度 MR 两组。分析基线、TAVR 后 7 天内的生存状态和超声心动图数据。
共纳入 1712 例患者。1404 例（82%）为无/轻度 MR，308 例（18%）为中/重度 MR。基线时中/重度 MR 导致 5 年随访时死亡率较高（校正 HR 1.29，95%CI 1.01-1.65，p=0.04）。以持续≤轻度 MR 为参照，若中/重度 MR 持续存在，或 TAVR 后从≤轻度 MR 进展为中/重度 MR，5 年死亡率更高（校正 HR 1.66，95%CI 1.17-2.34，p=0.04；校正 HR 1.97，95%CI 1.29-3.00，p=0.002）。若 TAVR 后中/重度 MR 改善至≤轻度 MR，则未见超额死亡率（HR 1.09，95%CI 0.75-1.58，p=0.67）。瓣周主动脉反流（PVL）与 TAVR 后 MR 改善呈负相关（OR 0.4，95%CI 0.17-0.94，p=0.034）。心房颤动（OR 2.1，95%CI 1.27-3.39，p=0.004）、自膨式瓣膜（OR 3.8，95%CI 2.08-7.14，p＜0.0001）和 PVL（OR 4.3，95%CI 2.32-7.78，p＜0.0001）与 MR 恶化相关。
TAVR 患者基线时中/重度 MR 与 5 年随访期间死亡率增加相关。如果 MR 改善至≤轻度，这种风险会降低，而 TAVR 后 MR 恶化与死亡率增加 2 倍相关。
