Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; St. Francis Hospital, The Heart Center, Roslyn, New York.
St. Francis Hospital, The Heart Center, Roslyn, New York.
Am J Cardiol. 2019 Nov 1;124(9):1449-1453. doi: 10.1016/j.amjcard.2019.07.038. Epub 2019 Aug 7.
The goal of this study was to determine the predictors of adverse clinical outcomes in patients treated with the MitraClip for significant mitral regurgitation (MR) with a focus on acute changes in hemodynamics and cardiac function. This retrospective study included 63 patients (mean age 82 ± 8 years, 48% male) with moderate to severe or severe MR. Cardiac catheterization was performed before and immediately after MitraClip repair. Volumetric and functional changes were assessed in both ventricles. A major adverse cardiac event was defined as a composite of cardiac death and readmission for heart failure. Patients were followed up on average for 380 days. MR was improved in 92% of patients after MitraClip therapy from an average grade of 4+ to <2+ (p <0.001). The pulmonary capillary wedge pressure decreased from 22 ± 7 mm Hg to 19 ± 6 mm Hg (p <0.001), and the cardiac stroke volume increased by 28% from 102 ± 53 ml to 131 ± 54 ml (p <0.001). The left ventricular end-diastolic volume was significantly reduced 24 hours after MitraClip therapy compared to that at baseline (p = 0.001). In the multivariate Cox proportion hazard regression model, an age ≥85 years (p <0.001) and residual MR >1+ (p <0.048) were predictors of an adverse prognosis at follow-up. In conclusion, a reduced left ventricular end-diastolic volume and improved hemodynamics occurred early after MitraClip therapy. An advanced age (≥85 years) and residual MR >1+ were associated with an increased risk of mortality and heart failure.
本研究旨在确定经 MitraClip 治疗的重度二尖瓣反流（MR）患者不良临床结局的预测因素，重点关注血液动力学和心功能的急性变化。这项回顾性研究纳入了 63 名（平均年龄 82 ± 8 岁，48%为男性）中至重度或重度 MR 的患者。在 MitraClip 修复前后进行了心导管检查。评估了两个心室的容积和功能变化。主要不良心脏事件定义为心脏死亡和心力衰竭再入院的复合事件。患者平均随访 380 天。MitraClip 治疗后，92%的患者 MR 得到改善，从平均 4+级降至<2+级（p<0.001）。肺毛细血管楔压从 22 ± 7 mmHg 降至 19 ± 6 mmHg（p<0.001），心搏量增加 28%，从 102 ± 53 ml 增加至 131 ± 54 ml（p<0.001）。与基线相比，MitraClip 治疗后 24 小时左心室舒张末期容积明显减少（p=0.001）。在多变量 Cox 比例风险回归模型中，年龄≥85 岁（p<0.001）和残余 MR>1+（p<0.048）是随访时不良预后的预测因素。总之，MitraClip 治疗后早期左心室舒张末期容积减少和血液动力学改善。高龄（≥85 岁）和残余 MR>1+与死亡率和心力衰竭风险增加相关。
