Gyoten Takayuki, Messroghli Daniel, Schenk Soeren, Rochor Kristin, Grimmig Oliver, Just Soeren, Fritzsche Dirk
Cardiac Surgery, Sana-Herzzentrum Cottbus, Cottbus, Brandenburg, Germany.
Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
Open Heart. 2020 Mar 15;7(1):e001203. doi: 10.1136/openhrt-2019-001203. eCollection 2020.
To evaluate the impact of preinterventional moderate-to-severe functional tricuspid regurgitation (FTR) on early outcome after percutaneous edge-to-edge mitral valve repair (pMVR) with MitraClip procedures for functional mitral regurgitation (FMR) in patients with heart failure with reduced ejection fraction (HFrEF).
From January 2013 to December 2017, 80 patients with HFrEF (ejection fraction 22%±5.3%) and FMR (grade 3.0±0.36) underwent successful pMVR. The 3-year actuarial survival was 58%. However, 73% (n=22) of non-survivors died of cardiac failure within 1 year. Patients were categorised into none-to-mild (n=36) and moderate-to-severe (n=44) postinterventional FTR groups according to pre-MitraClip tricuspid regurgitation grade. Cox regression analysis on 1-year survival demonstrated an impact of FTR severity (HR=1.8, 95% CI 1.01% to 3.09%, p=0.047), preoperative New York Heart Association class (HR=2.8, 95% CI 1.2% to 6.5%, p=0.015) and peripheral artery disease (HR=5.4, 95% CI 1.6 to 18, p=0.0054). Kaplan-Meier analysis showed that 1-year cardiac death was higher in the moderate-to-severe FTR group (p=0.048). In our study, 77% of pre-MitraClip moderate-to-severe FTR cannot be significantly reduced. Post-MitraClip moderate-to-severe FTR grade was related to lower survival (p<0.001).
In patients with HFrEF treated with MitraClip for FMR, moderate-to-severe FTR was an independent predictor of cardiac death within 1 year. To improve survival, additional therapy to residual FTR should be considered in early phase after MitraClip therapy.
评估射血分数降低的心力衰竭（HFrEF）患者中，介入治疗前的中重度功能性三尖瓣反流（FTR）对采用MitraClip手术进行经皮二尖瓣缘对缘修复（pMVR）治疗功能性二尖瓣反流（FMR）后早期结局的影响。
2013年1月至2017年12月，80例HFrEF（射血分数22%±5.3%）和FMR（3.0±0.36级）患者成功接受了pMVR。3年精算生存率为58%。然而，73%（n = 22）的非幸存者在1年内死于心力衰竭。根据MitraClip术前三尖瓣反流分级，将患者分为介入治疗后无至轻度（n = 36）和中至重度（n = 44）FTR组。对1年生存率的Cox回归分析显示，FTR严重程度（HR = 1.8，95%CI 1.01%至3.09%，p = 0.047）、术前纽约心脏协会分级（HR = 2.8，95%CI 1.2%至6.5%，p = 0.015）和外周动脉疾病（HR = 5.4，95%CI 1.6至18，p = 0.0054）有影响。Kaplan-Meier分析显示，中至重度FTR组1年心脏死亡率更高（p = 0.048）。在我们研究中，77%的MitraClip术前中至重度FTR无法显著降低。MitraClip术后中至重度FTR分级与较低生存率相关（p < 0.001）。
在接受MitraClip治疗FMR的HFrEF患者中，中至重度FTR是1年内心脏死亡的独立预测因素。为提高生存率，应在MitraClip治疗后的早期考虑对残余FTR进行额外治疗。
