经 MitraClip 治疗后伴有功能性二尖瓣反流的慢性心力衰竭患者的左心房整体功能

Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip.

机构信息

Heart Center Bonn, Department of Cardiology, University of Bonn, Bonn, Germany.

Center for Heart Vascular Medicine, Mediapark Köln, Cologne, Germany.

出版信息

Catheter Cardiovasc Interv. 2020 Sep 1;96(3):678-684. doi: 10.1002/ccd.28775. Epub 2020 Feb 17.

DOI:10.1002/ccd.28775

PMID:32065722

Abstract

BACKGROUND

Left atrial (LA) volumes and function are believed to improve following interventional reduction of mitral regurgitation (MR) with MitraClip. However, exact LA alterations after MitraClip in patients with functional MR and functional mitral regurgitation (FMR) are unknown.

OBJECTIVES

We aimed to evaluate the effect of MitraClip on LA volumes and global function in patients with FMR and its importance for patients' prognosis.

METHODS

All patients underwent three-dimensionally transthoracic echocardiography with an offline evaluation of LA geometry and strain analysis at baseline and follow-up (FU). FU examinations were planned for 6 and 12 months after MitraClip.

RESULTS

We prospectively included 50 consecutive surgical high-risk (logistic EuroSCORE: 17.2 ± 13.9%) patients (77 ± 9 years, 22% female) with symptomatic moderate-to-severe to severe functional MR without atrial fibrillation. Echocardiographic evaluation showed that the E/E' ratio was significantly higher at FU (15.6 ± 7.3, 24.1 ± 13.2, p = .05) without relevant changes in systolic left ventricle (LV) function (p = .5). LA volumes (end-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) (LA-EDV: 83.1 ± 39.5 ml, 115.1 ± 55.3 ml, p = .012; LA-ESV: 58.4 ± 33.4 ml, 80.1 ± 43.9 ml, p = .031), muscular mass (105.1 ± 49.3 g, 145.4 ± 70.6 g, p = .013), as well as LA stroke volume (24.6 ± 12.5 ml, 34.9 ± 19.1 ml, p = .016) significantly increased after the procedure. LA ejection fraction (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p = .8) and atrial global strain (aGS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = .4) showed no significant changes at FU. Despite no relevant changes during FU, the baseline aGS was found to be the strongest predictor for mortality and adverse interventional outcome.

CONCLUSION

MitraClip increases atrial stroke volume, atrial volumes, and muscular mass in patients with FMR. We found that the baseline aGS the strongest predictor for mortality, rehospitalization, and higher residual MR at FU.

摘要

背景

人们认为，通过介入手段减轻二尖瓣反流（MR）并用 MitraClip 夹闭可以改善左心房（LA）容量和功能。然而，对于功能性 MR 和功能性二尖瓣反流（FMR）患者，MitraClip 后确切的 LA 改变尚不清楚。

目的

我们旨在评估 MitraClip 对 FMR 患者 LA 容量和整体功能的影响及其对患者预后的重要性。

方法

所有患者均接受三维经胸超声心动图检查，在基线和随访（FU）时进行 LA 几何形状和应变分析的离线评估。FU 检查计划在 MitraClip 后 6 个月和 12 个月进行。

结果

我们前瞻性纳入了 50 例连续接受手术治疗的高危（逻辑 EuroSCORE：17.2±13.9%）患者（77±9 岁，22%为女性），这些患者患有有症状的中度至重度至重度功能性 MR 且无房颤。超声心动图评估显示，FU 时 E/E' 比值显著升高（15.6±7.3，24.1±13.2，p=0.05），但左心室收缩功能无明显变化（p=0.5）。LA 容积（舒张末期容积[LA-EDV]和收缩末期容积[LA-ESV]）（LA-EDV：83.1±39.5 ml，115.1±55.3 ml，p=0.012；LA-ESV：58.4±33.4 ml，80.1±43.9 ml，p=0.031）、肌质量（105.1±49.3 g，145.4±70.6 g，p=0.013）以及 LA 每搏量（24.6±12.5 ml，34.9±19.1 ml，p=0.016）在手术后均显著增加。LA 射血分数（LA-EF：31.7±12.8%，31.1±12.3%，p=0.8）和心房整体应变（aGS：-10.8±5.4%，-9.7±4.45%，p=0.4）在 FU 期间无明显变化。尽管 FU 期间无明显变化，但基线 aGS 被发现是死亡率和不良介入结果的最强预测因子。