Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California.
Am J Cardiol. 2021 Aug 15;153:109-118. doi: 10.1016/j.amjcard.2021.05.025. Epub 2021 Jun 29.
Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exists on pre-MDCT parameters predicting high transmitral pressure gradient (TMPG) post-MitraClip procedure. We analyzed the preprocedural MDCTs of 156 consecutive patients with mitral regurgitation undergoing MitraClip implantation at our institution. The mean TMPG was assessed by periprocedural transesophageal and pre-discharge transthoracic echocardiography. MDCT-derived mitral annulus area (MAA), anterior-posterior (AP) and medial-lateral (ML) mitral annulus diameters, and mitral valve orifice area (MVOA) were smaller in patients with mean TMPG ≥5 mmHg than those with mean TMPG <5 mmHg after 1-or 2-clip implantation. Small MAA, AP and ML diameters, and MVOA were moderately correlated with high TMPG post-MitraClip, in which MAA and MVOA had the highest degree of correlation after 1-clip (r = -0.46 both), whereas MAA and ML had the strongest degree of correlation after 2-clip (r = -0.39 both) and at discharge (r = -0.38 both). From the receiver-operating-characteristic curve analyses, no significant differences in the area under the curve were observed among these MDCT parameters for low TMPG after MitraClip implantation, except for those between MAA and AP diameter at discharge (p=0.026). For optimal cutoff values, MAA ≥1100 and ≥1300 mm had positive predictive values of 89% and 91%, while both MAA ≥750 and ≥900 mm had negative predictive values of 100%, for mean TMPG <5 mmHg after 1-and 2-clip implantation, respectively. In conclusion, in patients undergoing the MitraClip procedure, preprocedural MDCT parameters are useful to predict postprocedural mitral stenosis.
多排螺旋计算机断层扫描（MDCT）可为经导管二尖瓣介入治疗的术前规划提供有价值的信息。然而，对于预测二尖瓣夹合术（MitraClip）后跨瓣压力梯度（TMPG）较高的术前 MDCT 参数尚无相关数据。我们分析了我院 156 例连续接受 MitraClip 植入术的二尖瓣反流患者的术前 MDCT。术中经食管超声心动图（TEE）和术前经胸超声心动图（TTE）评估平均 TMPG。MitraClip 植入术后 1 或 2 个夹子后，平均 TMPG≥5mmHg 的患者的 MDCT 衍生的二尖瓣瓣环面积（MAA）、前后径（AP）和内外径（ML）、二尖瓣瓣口面积（MVOA）均小于平均 TMPG＜5mmHg 的患者。较小的 MAA、AP 和 ML 直径和 MVOA 与 MitraClip 术后 TMPG 较高中度相关，其中 MAA 和 MVOA 在植入 1 个夹子后相关性最高（两者均 r=-0.46），而 MAA 和 ML 在植入 2 个夹子后相关性最强（两者均 r=-0.39），在出院时相关性最强（两者均 r=-0.38）。从受试者工作特征曲线分析，除 MAA 与出院时 AP 直径之间（p=0.026）外，这些 MDCT 参数在 MitraClip 植入术后低 TMPG 中的曲线下面积无显著差异。对于最佳截断值，MAA≥1100mm 和≥1300mm 对植入 1 个和 2 个夹子后平均 TMPG＜5mmHg 的阳性预测值分别为 89%和 91%，而 MAA≥750mm 和≥900mm 的阴性预测值均为 100%。总之，在接受 MitraClip 手术的患者中，术前 MDCT 参数可用于预测术后二尖瓣狭窄。
