Department of Cardiology and Paris Cardiovascular Research Center (INSERM U970), European Hospital Georges Pompidou, Paris, France.
Medizinische Klinik und Poliklinik I, Ludwig Maximilians Universität München, Munich, Germany.
Clin Res Cardiol. 2021 May;110(5):732-739. doi: 10.1007/s00392-021-01807-0. Epub 2021 Mar 4.
To assess the value of effective regurgitant orifice (ERO) in predicting outcome after edge-to-edge transcatheter mitral valve repair (TMVR) for secondary mitral regurgitation (SMR) and identify the optimal cut-off for patients' selection.
Using the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry, that included patients undergoing edge-to-edge TMVR for SMR between November 2008 and January 2019 in 8 experienced European centres, we assessed the optimal ERO threshold associated with mortality in SMR patients undergoing TMVR, and compared characteristics and outcomes of patients according to baseline ERO.
Among 1062 patients with severe SMR and ERO quantification by proximal isovelocity surface area method in the registry, ERO was < 0.3 cm in 575 patients (54.1%), who were more symptomatic at baseline (NYHA class ≥ III: 91.4% vs. 86.9%, for ERO < vs. ≥ 0.3 cm; P = 0.004). There was no difference in all-cause mortality at 2-year follow-up according to baseline ERO (28.3% vs. 30.0% for ERO < vs. ≥ 0.3 cm, P = 0.585). Both patient groups demonstrated significant improvement of at least one NYHA class (61.7% and 73.8%, P = 0.002), resulting in a prevalence of NYHA class ≤ II at 1-year follow-up of 60.0% and 67.4% for ERO < vs. ≥ 0.3 cm, respectively (P = 0.05).
All-cause mortality at 2 years after TMVR does not differ if baseline ERO is < or ≥ 0.3 cm, and both groups exhibit relevant clinical improvements. Accordingly, TMVR should not be withheld from patients with ERO < 0.3 cm who remain symptomatic despite optimal medical treatment, if TMVR appropriateness was determined by experienced teams in dedicated valve centres.
评估有效瓣口反流面积（ERO）在预测二尖瓣缘对缘修复术（TMVR）治疗继发性二尖瓣反流（SMR）患者结局中的价值，并确定适合患者选择的最佳 ERO 截断值。
利用欧洲经导管二尖瓣修复术治疗继发性二尖瓣反流（EuroSMR）注册研究，该研究纳入了 2008 年 11 月至 2019 年 1 月期间 8 家欧洲经验丰富的中心采用 TMVR 治疗 SMR 的患者，我们评估了 ERO 与 SMR 患者 TMVR 后死亡率之间的关联，并比较了根据基线 ERO 值分组的患者特征和结局。
在注册研究中，1062 例严重 SMR 患者中通过近端等速表面积法对 ERO 进行了定量评估，575 例患者（54.1%）的 ERO<0.3cm，这些患者的基线症状更明显（NYHA 分级≥III级：ERO<0.3cm 的患者占 91.4%，ERO≥0.3cm 的患者占 86.9%；P=0.004）。根据基线 ERO 值，2 年随访时的全因死亡率无差异（ERO<0.3cm 的患者为 28.3%，ERO≥0.3cm 的患者为 30.0%；P=0.585）。两组患者均至少改善了一个 NYHA 分级（ERO<0.3cm 的患者占 61.7%，ERO≥0.3cm 的患者占 73.8%；P=0.002），导致 1 年随访时 NYHA 分级≤II 级的比例分别为 60.0%和 67.4%（ERO<0.3cm 的患者为 60.0%，ERO≥0.3cm 的患者为 67.4%；P=0.05）。
TMVR 治疗后 2 年的全因死亡率不因基线 ERO<0.3cm 或 ERO≥0.3cm 而有所不同，且两组均表现出明显的临床改善。因此，如果在专门的瓣膜中心由经验丰富的团队确定 TMVR 适应证，那么对于即使经过最佳药物治疗仍有症状的 ERO<0.3cm 的患者，不应拒绝行 TMVR 治疗。
