Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany.
Department of Cardiology, University Heart Center Eppendorf, Hamburg, Germany.
Eur J Heart Fail. 2020 Jul;22(7):1202-1210. doi: 10.1002/ejhf.1820. Epub 2020 Apr 4.
Left atrial (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair, LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.
Data from the multicentre German TRAnscatheter Mitral valve Interventions registry (TRAMI) were used to analyse the association of baseline LA diameter by tertiles with efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with MitraClip. In 520 of 843 patients prospectively enrolled in TRAMI, baseline LA diameter were reported [median (interquartile range) LA diameter in tertiles: 44 (40-46) mm, 51 (48-53) mm and 60 (55-66) mm]. Larger LA diameters were significantly associated with secondary aetiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all P < 0.05). Technical success was not different across tertiles (96%, 95.4% and 98.4%, respectively; P = 0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke: 1.8%, 1.2% and 4.4%, respectively; P = 0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7%, respectively; P < 0.01), as did hospitalization in survivors (60%, 67.6% and 78.9%, respectively; P < 0.05). The association between LA diameter and outcome remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.
Left atrial enlargement is a strong and independent predictor of adverse long-term outcome after transcatheter mitral valve repair. Further study is warranted to examine whether timely intervention may have the potential to modify outcome.
左心房（LA）大小是原发性和继发性二尖瓣反流疾病严重程度和预后的标志物。在经导管二尖瓣修复术中，LA 增大可能通过改变解剖结构和心房环扩张，影响器械处理和技术成功率。
利用多中心德国经导管二尖瓣介入治疗注册研究（TRAMI）的数据，分析了在接受 MitraClip 边缘到边缘修复的患者中，基线 LA 直径按三分位与疗效、安全性和长期临床结局的相关性。在 TRAMI 前瞻性纳入的 843 例患者中的 520 例患者中，报告了基线 LA 直径[三分位的中位数（四分位距）LA 直径：44（40-46）mm、51（48-53）mm 和 60（55-66）mm]。较大的 LA 直径与二尖瓣反流的继发性病因、射血分数较低、左心室较大、男性和心房颤动显著相关（均 P<0.05）。三分位组间的技术成功率无差异（分别为 96%、95.4%和 98.4%；P=0.43），主要院内心血管和脑不良事件（死亡率、心肌梗死或中风）也无差异（分别为 1.8%、1.2%和 4.4%；P=0.11）。然而，随着 LA 直径的增大，4 年死亡率显著增加（分别为 32.9%、46.4%和 51.7%；P<0.01），幸存者的住院率也增加（分别为 60%、67.6%和 78.9%；P<0.05）。多变量调整包括基线左心室舒张末期直径后，LA 直径与结局的相关性仍然显著。
LA 增大是经导管二尖瓣修复术后不良长期结局的一个强烈且独立的预测因素。需要进一步研究以评估及时干预是否有可能改变结局。
