Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2021 May 1;97(6):1244-1249. doi: 10.1002/ccd.29477. Epub 2021 Jan 27.
Change in left atrial pressure (LAP) has been shown to be associated with symptom improvement post-MitraClip; however, the association between acute procedural changes in transmitral diastolic mean gradient (MG) compared to LAP and symptom improvement is not well established.
164 consecutive patients undergoing MitraClip at Mayo Clinic between June 2014 and May 2018 were included. Preclip and postclip MG and LAP were recorded. Baseline demographics, clinical, and echocardiographic outcomes, including 30-day New York Heart Association (NYHA) functional status were obtained from patient charts.
Median age was 81.5 years (IQR: 76.3, 87), 34% were female and 94.5% had NYHA class III and IV functional status at baseline. At baseline, median MG was 4 mmHg (IQR: 3, 5) and LAP was 19 mmHg (IQR: 16, 23.5). Following MitraClip deployment, the median MG was 4 mmHg (IQR: 3, 6) and the median LAP was 17 mmHg (IQR: 14, 21), 69.5% of patients had less than moderate MR. There was no statistically significant association between change in MG and NYHA functional class at 30 days (OR = 0.95, 95% CI: 0.76-1.20). However, a reduction in LAP following MitraClip deployment was significantly associated with improvement in NYHA functional status at 30 days following adjustments for age and sex (aOR 3.36, 95% CI: 1.34-8.65). There was no significant correlation between change in mean LAP and change in MG (p = .98).
Unlike change in left atrial pressure, change in MG post-MitraClip was not associated with patient reported outcomes at 30 days and did not correlate with change in left atrial pressure. Long-term follow up is needed to evaluate the impact of LA pressure on symptoms.
左心房压力 (LAP) 的变化已被证明与 MitraClip 术后症状改善相关；然而，与 LAP 相比，经二尖瓣舒张平均梯度 (MG) 的急性手术变化与症状改善之间的关系尚未得到很好的确定。
本研究纳入了 2014 年 6 月至 2018 年 5 月期间在 Mayo 诊所接受 MitraClip 的 164 例连续患者。记录术前和术后的 MG 和 LAP。从患者病历中获取基线人口统计学、临床和超声心动图结果，包括 30 天纽约心脏协会 (NYHA) 功能状态。
中位年龄为 81.5 岁（IQR：76.3，87），34%为女性，94.5%在基线时具有 NYHA 功能 III 级和 IV 级。在基线时，MG 的中位数为 4mmHg（IQR：3，5），LAP 的中位数为 19mmHg（IQR：16，23.5）。MitraClip 植入后，MG 的中位数为 4mmHg（IQR：3，6），LAP 的中位数为 17mmHg（IQR：14，21），69.5%的患者存在中度以下的 MR。MG 的变化与 30 天 NYHA 功能分类之间没有统计学显著关联（OR=0.95，95%CI：0.76-1.20）。然而，在调整年龄和性别后，MitraClip 植入后 LAP 的降低与 30 天后 NYHA 功能状态的改善显著相关（aOR 3.36，95%CI：1.34-8.65）。平均 LAP 的变化与 MG 的变化之间没有显著相关性（p=0.98）。
与左心房压力的变化不同，MitraClip 术后 MG 的变化与 30 天患者报告的结果无关，并且与左心房压力的变化无关。需要进行长期随访以评估左心房压力对症状的影响。
