Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy.
Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy; Department of Clinical Sciences, Lund University, Clinical Research Center, Skåne University Hospital, Malmö 205-02, Sweden.
Cardiovasc Revasc Med. 2020 Jul;21(7):857-864. doi: 10.1016/j.carrev.2019.11.003. Epub 2019 Nov 15.
The benefit of percutaneous mitral valve repair (PMVR) in patients with secondary MR is still debated. We aimed to compare the outcome of PMVR with optimal medical therapy (OMT) versus OMT alone in patients with secondary mitral regurgitation (MR) and to assess the role of potential effect modifiers.
We performed a systematic review and meta-analysis of 2 randomized clinical trials (RCT) and 7 non-randomized observational studies (nROS). Hazard ratios (HR) and 95% confidence intervals (CI) were pooled through inverse variance random-effects model to compute the summary effect size for all-cause death, cardiovascular death and cardiac-related hospitalization. Subgroup and meta-regression analysis were also performed.
An overall population of 3118 individuals (67% men; mean age, 73 years) was included: 1775 PMVR+OMT and 1343 OMT patients, with mean follow-up of 24 ± 15 months. PMVR+OMT was associated with a lower risk of all-cause death (HR: 0.77; 95% CI: 0.68-0.87), cardiovascular death (HR: 0.55; 95% CI: 0.34-0.89) and cardiac-related hospitalization (HR:0.77; 95% CI: 0.64-0.92). Meta-regression analysis showed that larger left ventricular end-diastolic volume index (LVEDVI) portends higher risk of all-cause death, cardiovascular death and cardiac-related hospitalization after PMVR (p < 0.001 for all).
This study-level meta-analysis shows that PMVR+OMT is associated with reduced all-cause death, cardiovascular death and cardiac-related hospitalization when compared with OMT alone in secondary MR. LVEDVI is a predictive marker of efficacy, as patients with smaller LVEDVI have been shown to derive the largest benefit from PMVR.
经皮二尖瓣修复术（PMVR）治疗继发性二尖瓣反流（MR）的获益仍存在争议。我们旨在比较 PMVR 联合最佳药物治疗（OMT）与单纯 OMT 治疗继发性 MR 患者的结局，并评估潜在的效应修饰因子的作用。
我们对 2 项随机临床试验（RCT）和 7 项非随机观察性研究（nROS）进行了系统评价和荟萃分析。使用逆方差随机效应模型汇总所有原因死亡、心血管死亡和心脏相关住院的风险比（HR）和 95%置信区间（CI），以计算汇总效应大小。还进行了亚组和荟萃回归分析。
共纳入 3118 例患者（67%为男性；平均年龄为 73 岁）：1775 例 PMVR+OMT 和 1343 例 OMT 患者，平均随访 24±15 个月。PMVR+OMT 可降低全因死亡（HR：0.77；95%CI：0.68-0.87）、心血管死亡（HR：0.55；95%CI：0.34-0.89）和心脏相关住院（HR：0.77；95%CI：0.64-0.92）的风险。荟萃回归分析显示，较大的左心室舒张末期容积指数（LVEDVI）预示着 PMVR 后全因死亡、心血管死亡和心脏相关住院的风险更高（p<0.001）。
这项研究水平的荟萃分析表明，与单纯 OMT 相比，PMVR+OMT 可降低继发性 MR 患者的全因死亡、心血管死亡和心脏相关住院风险。LVEDVI 是疗效的预测指标，因为 LVEDVI 较小的患者从 PMVR 中获益最大。
