Cardiology Division, Tel Aviv Sourasky Medical Center, Sackler faculty of Medicine, Tel Aviv, Israel; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Cardiology Division, Tel Aviv Sourasky Medical Center, Sackler faculty of Medicine, Tel Aviv, Israel.
Int J Cardiol. 2020 Jan 15;299:215-221. doi: 10.1016/j.ijcard.2019.07.092. Epub 2019 Aug 1.
While the impact of mitral regurgitation (MR) prior to transcatheter aortic valve replacement (TAVR) has been intensively studied, the implications of post-procedural MR on outcome are unknown. We investigated the clinical and physiological impact of significant MR after TAVR.
Clinical and echocardiographic data of 486 patients who underwent TAVR between March 2009 and December 2014 were evaluated. Clinical endpoints included overall mortality and combined endpoint of mortality, heart failure re-hospitalization and new atrial fibrillation. Echocardiographic parameters were analyzed at baseline, 30-day and 6-month after TAVR.
MR severity improved in 25%, worsened in 19% and did not change in 56% of patients 30-days post TAVR (p = 0.3). Post TAVR MR grade ≥ moderate was present in 16.1%. Predictive accuracy of post TAVR MR was low (AUC = 0.63). Median follow-up was 4.3 years (interquartile range, 2.5 to 6.1). Post TAVR MR grade ≥ moderate was associated with increased mortality and combined cardiac events (p = 0.013 and p < 0.001) even when adjusted for all clinical and echo parameters and when analyzed with propensity score matching. In patients with MR ≥ moderate, LV filling pressure and RV hemodynamics worsened 6 months post TAVR, while improving in patients with less significant post procedural MR.
Post procedural, but not pre-procedural MR grade ≥ moderate was independently associated with mortality and adverse cardiac events after TAVR. Significant MR post TAVR resulted in adverse LV and RV remodeling and poor hemodynamic. Our study strengthens the rational for initiating early treatment to reduce post TAVR MR.
虽然经导管主动脉瓣置换术（TAVR）前二尖瓣反流（MR）的影响已得到深入研究，但术后 MR 对预后的影响尚不清楚。我们研究了 TAVR 后严重 MR 对临床和生理的影响。
评估了 2009 年 3 月至 2014 年 12 月期间接受 TAVR 的 486 例患者的临床和超声心动图数据。临床终点包括总死亡率和死亡率、心力衰竭再住院和新发心房颤动的联合终点。TAVR 后 30 天和 6 个月分析超声心动图参数。
TAVR 后 30 天，MR 严重程度改善 25%，恶化 19%，56%的患者无变化（p=0.3）。TAVR 后 MR 分级≥中度的患者为 16.1%。TAVR 后 MR 的预测准确性较低（AUC=0.63）。中位随访时间为 4.3 年（四分位间距，2.5 至 6.1）。TAVR 后 MR 分级≥中度与死亡率和心脏不良事件增加相关（p=0.013 和 p<0.001），即使在调整所有临床和超声心动图参数后，甚至在使用倾向评分匹配进行分析时也是如此。在 MR≥中度的患者中，LV 充盈压和 RV 血流动力学在 TAVR 后 6 个月恶化，而在 MR 程度较轻的患者中改善。
TAVR 后而非 TAVR 前的 MR 分级≥中度与 TAVR 后死亡率和心脏不良事件独立相关。TAVR 后严重的 MR 导致 LV 和 RV 重塑不良和血流动力学不良。我们的研究加强了早期治疗以降低 TAVR 后 MR 的合理性。
