Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands.
JACC Cardiovasc Imaging. 2021 Apr;14(4):756-765. doi: 10.1016/j.jcmg.2020.08.019. Epub 2020 Oct 28.
The purpose of this study was to determine whether the mitral valve (MV) total leaflet area (TLA)-to-mitral annular area (MAA) (TLA/MAA) ratio measured using 3-dimensional (3D) transesophageal echocardiography (TEE) was associated with residual mitral regurgitation (MR) after MitraClip implantation in patients with secondary MR.
The factors influencing the results of MitraClip implantation for secondary MR are controversial. This study hypothesized that insufficient remodeling of the mitral leaflets relative to the annular dilation may be associated with significant MR after MitraClip implantation.
This study included patients with secondary MR treated with MitraClips. Using 3D TEE dataset, the TLA in diastole and MAA in systole were measured with dedicated software.
In a total cohort of 119 patients (mean age 74 ± 9 years; 61% male), significant residual MR (≥2+) was present in 43 patients (36%). In patients with significant residual MR, MAA was greater than in patients without residual MR (10.7 ± 2.4 cm vs. 9.0 ± 2.1 cm; p < 0.001) whereas no significant difference was observed in TLA (12.2 ± 2.6 cm vs. 12.0 ± 2.9 cm; p = 0.836). TLA/MAA ratio was lower in patients with significant residual MR as compared to their counterparts (1.14 ± 0.15 vs. 1.34 ± 0.16; p < 0.001), suggesting insufficient leaflet remodeling relative to annular dilation. On receiver-operating characteristic curve analysis, the TLA/MAA ratio had better discriminative power to identify patients who will have significant residual MR compared to MAA alone (area under the curve [AUC]: 0.830 vs. 0.723; p = 0.049).
In patients with secondary MR, insufficient mitral leaflet remodeling relative to the annulus dilation, as reflected by a lower TLA/MAA ratio, is associated with significant residual MR after MitraClip implantation.
本研究旨在探讨经食管三维超声心动图（TEE）测量二尖瓣（MV）总瓣叶面积（TLA）与二尖瓣环面积（MAA）的比值（TLA/MAA）与继发MR 患者行 MitraClip 植入术后残余 MR 的关系。
影响 MitraClip 植入治疗继发 MR 效果的因素存在争议。本研究假设二尖瓣瓣叶相对于瓣环扩张的重塑不足可能与 MitraClip 植入术后严重 MR 相关。
本研究纳入了接受 MitraClip 治疗的继发 MR 患者。使用三维 TEE 数据集，专用软件测量舒张期 TLA 和收缩期 MAA。
在总共 119 例患者（平均年龄 74 ± 9 岁，61%为男性）中，43 例（36%）患者存在明显残余 MR（≥2+）。在有明显残余 MR 的患者中，MAA 大于无残余 MR 的患者（10.7 ± 2.4 cm 比 9.0 ± 2.1 cm；p<0.001），而 TLA 无显著差异（12.2 ± 2.6 cm 比 12.0 ± 2.9 cm；p=0.836）。与对照组相比，有明显残余 MR 的患者 TLA/MAA 比值较低（1.14 ± 0.15 比 1.34 ± 0.16；p<0.001），表明瓣叶相对于瓣环扩张的重塑不足。在接受者操作特征曲线分析中，与单独使用 MAA 相比，TLA/MAA 比值对识别将发生明显残余 MR 的患者具有更好的鉴别能力（曲线下面积 [AUC]：0.830 比 0.723；p=0.049）。
在继发 MR 患者中，二尖瓣瓣叶相对于瓣环扩张的重塑不足，表现为较低的 TLA/MAA 比值，与 MitraClip 植入术后严重残余 MR 相关。
