Transcatheter Heart Valves Department, HYGEIA Hospital, Athens, Greece.
Echocardiography Laboratory, European Interbalkan Medical Center, Thessaloniki, Greece.
ESC Heart Fail. 2020 Aug;7(4):1409-1418. doi: 10.1002/ehf2.12750. Epub 2020 May 20.
The purpose of this study is to identify echocardiography predictors of clinical response and reverse left ventricular (LV) remodelling in patients with functional mitral regurgitation (FMR) treated with MitraClip.
We retrospectively analysed 86 high surgical risk patients with severe FMR; of those, 58 were implanted a MitraClip, and 28 received medical treatment and served as controls. At baseline and at 1-year follow-up, we performed clinical and echocardiography evaluation to assess global longitudinal strain (GLS) and myocardial work [global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE)]. Mitral regurgitation was significantly reduced after MitraClip implantation (3.7 ± 0.4 vs. 1.7 ± 0.8, P < 0.001), and the procedure was associated with improvement in brain natriuretic peptide levels (980 ± 1027 vs. 420 ± 338 pg/mL, P < 0.001), New York Heart Association class status (3.2 ± 0.55 vs. 2.0 ± 0.6, P < 0.001), 6-min walking test (233 ± 154 vs. 286 ± 114 m, P = 0.01) at follow-up and reduction of left ventricle end-systolic (LVESV) and left ventricle end-diastolic volumes (LVEDV) (152 ± 68 vs. 136 ± 43 mL, P = 0.004 & 219 ± 74 vs. 193 ± 66 mL, P = 0.001, respectively). MitraClip procedure was associated with improvement of LV performance and significant increase of GWI (607 ± 282 vs. 650 ± 260 mmHg%, P = 0.045) and GCW (854 ± 288 vs. 949 ± 325 mmHg%, P < 0.001). Baseline ejection fraction (EF), GLS, GWI, GCW, and effective regurgitant orifice area were the variables that were associated with reduction of LVEDV 1 year after intervention (P < 0.05 for all) and baseline GCW of the LV was the only variable associated with reduction of LVESV (P = 0.002). Receiver operating characteristic curve analysis identified that a GLS cut-off value of -8.65% (AUC 0.815, P = 0.007) was associated with a 20% reduction of the LVEDV with a sensitivity and specificity of 72% and 70%, respectively, and that a GCW cut-off value of 846 mmHg% (AUC 0.759, P = 0.007) was associated with a 10% reduction of LVESV with sensitivity and specificity 79% and 74%, respectively.
Mitral valve repair with MitraClip has positive clinical and echocardiographic impact in patients with FMR 1 year after implantation. Preserved GLS and GCW values appear to be associated with LV reverse remodelling post intervention.
本研究旨在确定经皮二尖瓣夹合术（MitraClip）治疗功能性二尖瓣反流（FMR）患者的超声心动图预测临床反应和左心室（LV）逆重构的指标。
我们回顾性分析了 86 例高危外科手术的严重 FMR 患者；其中 58 例植入了 MitraClip，28 例接受了药物治疗作为对照组。在基线和 1 年随访时，我们进行了临床和超声心动图评估，以评估整体纵向应变（GLS）和心肌做功[整体做功指数（GWI）、整体构建功（GCW）、整体浪费功（GWW）、整体做功效率（GWE）]。MitraClip 植入后二尖瓣反流显著减少（3.7±0.4 比 1.7±0.8，P<0.001），该手术与脑利钠肽水平的改善相关（980±1027 比 420±338 pg/mL，P<0.001）、纽约心功能协会（NYHA）分级状态（3.2±0.55 比 2.0±0.6，P<0.001）、6 分钟步行试验（233±154 比 286±114 m，P=0.01），并降低左心室收缩末期（LVESV）和左心室舒张末期容积（LVEDV）（152±68 比 136±43 mL，P=0.004 和 219±74 比 193±66 mL，P=0.001）。MitraClip 手术与 LV 功能的改善相关，并显著增加 GWI（607±282 比 650±260 mmHg%，P=0.045）和 GCW（854±288 比 949±325 mmHg%，P<0.001）。基线射血分数（EF）、GLS、GWI、GCW 和有效反流口面积与术后 1 年 LVEDV 的减少相关（所有 P<0.05），而基线 GCW 是与 LVESV 减少相关的唯一变量（P=0.002）。受试者工作特征曲线分析确定 GLS 截断值为-8.65%（AUC 0.815，P=0.007）与 LVEDV 减少 20%相关，其敏感性和特异性分别为 72%和 70%，GCW 截断值为 846 mmHg%（AUC 0.759，P=0.007）与 LVESV 减少 10%相关，敏感性和特异性分别为 79%和 74%。
MitraClip 修复二尖瓣在 FMR 患者植入后 1 年具有积极的临床和超声心动图影响。保留的 GLS 和 GCW 值似乎与介入后的 LV 逆重构相关。
