Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome.
Department of Cardiac Surgery, University of Genoa, Genoa, Italy.
J Cardiovasc Med (Hagerstown). 2020 May;21(5):383-390. doi: 10.2459/JCM.0000000000000968.
Moderate-to-severe mitral regurgitation is present in 20-35% of patients undergoing transcatheter aortic valve replacement (TAVR) and the current literature lacks simple echocardiographic parameters, which can predict post-TAVR changes in mitral regurgitation. The aim of this study is to investigate the echocardiographic predictors of improvement or worsening of mitral regurgitation in patients undergoing TAVR with moderate-to-severe mitral regurgitation.
This retrospective study included 113 patients who underwent TAVR with preoperative mitral regurgitation grade at least 2. Patients with concomitant coronary artery disease requiring treatment were excluded. Mitral regurgitation was related to the annular dilatation or tethering mechanism in all patients. Preoperative and postoperative echocardiographies were compared in terms of mitral regurgitation and other commonly measured parameters.
After TAVR, a reduction in mitral regurgitation was observed in 62.8% of cases. On the basis of the difference between postoperative and preoperative echocardiograms, 71 patients had improved mitral regurgitation, whereas 42 patients had stable or worsened mitral regurgitation. After analyzing preoperative echocardiographic parameters with regard to this group difference, left atrial volume index (LAVI) was the only variable that was different between groups (33.4 ± 4.8 ml/m in improved mitral regurgitation vs. 39.8 ± 3.0 ml/m in not improved mitral regurgitation, P < 0.001). In a multivariable logistic regression model, a LAVI increase was associated with lack of an acute reduction in mitral regurgitation (odds ratio = 1.41, P < 0.001) after adjustment for age and preoperative serum creatinine.
Higher preoperative LAVI is a determinant predictor of lack of an acute reduction in mitral regurgitation after TAVR, and LAVI could be used as a stratifying tool to tailor the treatment strategy and the timing of the procedures. However, validation of these results and long-term outcomes are warranted to support those conclusions.
经导管主动脉瓣置换术（TAVR）患者中有 20-35%存在中重度二尖瓣反流，而目前的文献缺乏可预测 TAVR 后二尖瓣反流变化的简单超声心动图参数。本研究旨在探讨中重度二尖瓣反流患者行 TAVR 后二尖瓣反流改善或恶化的超声心动图预测因素。
本回顾性研究纳入了 113 例术前二尖瓣反流分级至少为 2 级的行 TAVR 患者。排除同时存在需要治疗的冠状动脉疾病的患者。所有患者的二尖瓣反流均与瓣环扩张或牵张机制有关。比较了 TAVR 前后的超声心动图和其他常用测量参数。
TAVR 后，62.8%的患者二尖瓣反流减轻。根据术后和术前超声心动图的差异，71 例患者的二尖瓣反流改善，而 42 例患者的二尖瓣反流稳定或恶化。分析术前超声心动图参数与组间差异，左心房容积指数（LAVI）是唯一存在差异的变量（改善组为 33.4±4.8ml/m，未改善组为 39.8±3.0ml/m，P<0.001）。在多变量逻辑回归模型中，LAVI 增加与 TAVR 后二尖瓣反流无急性减轻相关（调整年龄和术前血清肌酐后，比值比=1.41，P<0.001）。
较高的术前 LAVI 是 TAVR 后二尖瓣反流无急性减轻的决定因素预测指标，LAVI 可作为分层工具，以调整治疗策略和手术时机。然而，需要验证这些结果和长期结局以支持这些结论。
