Department of Cardiology, Heart Center, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany.
Clin Res Cardiol. 2020 Oct;109(10):1261-1270. doi: 10.1007/s00392-020-01618-9. Epub 2020 Feb 18.
The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR).
Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR.
Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement.
15.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality.
Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Factors associated with MR persistence or regression after TAVR.
本研究旨在评估经导管主动脉瓣置换术（TAVR）后二尖瓣反流（MR）改善的影像学预测因素，并评估 MR 消退对患者长期预后的影响。
在严重主动脉瓣狭窄患者中，并发 MR 是一种常见发现，但在 TAVR 时通常不予治疗。
对 677 例连续严重主动脉瓣狭窄患者行 TAVR 前后经胸超声心动图（TTE）评估 MR。2 年死亡率与基线和出院时 MR 程度相关。进行形态回声分析以确定 MR 改善的预测因素。
15.2%的患者基线 MR≥3+，2 年生存率显著降低（57.7%比 74.4%，P<0.001）。TAVR 后 50%的患者 MR 得到改善，44%的患者 MR 减轻至≤2+。与持续 MR≥3+的患者相比，MR 改善至≤2+与生存率显著提高相关。基线参数包括非严重基线 MR、二尖瓣环钙化程度和大环形尺寸（≥32mm）预测了 MR 改善至≤2+的可能性。基于这些参数的评分选择了 TAVR 后 MR≤2+的概率不同的组，范围从 10.5%到 94.4%（AUC 0.816；P<0.001），并预测了 2 年死亡率。
未解决的严重 MR 是 TAVR 后长期死亡率的关键决定因素。TAVR 后严重 MR 的持续存在可以使用从 TTE 成像中获得的选定参数来预测。这些数据呼吁在这一亚组中密切随访和额外的二尖瓣治疗。与 TAVR 后 MR 持续或消退相关的因素。
