Witte Klaus K, Kaye David M, Lipiecki Janusz, Siminiak Tomasz, Goldberg Steven L, von Bardeleben Ralph S, Sievert Horst, Levy Wayne C, Starling Randall C
Department of Internal Medicine I, University Clinic, RWTH Aachen University, Aachen, Germany.
Department of Cardiology, Alfred Hospital, Melbourne, Australia.
Eur J Heart Fail. 2021 Nov;23(11):1971-1978. doi: 10.1002/ejhf.2310. Epub 2021 Aug 4.
To determine the effects of percutaneous mitral annuloplasty on symptoms, walk distance and left ventricular (LV) structure and function in patients with mild or moderate secondary mitral regurgitation (SMR).
This was a pooled analysis of patients (n = 68) who, despite guideline-directed medical therapy had symptomatic heart failure (HF) with mild (n = 25) or moderate (n = 43) SMR treated with percutaneous mitral annuloplasty as part of the TITAN, TITAN II, or REDUCE-FMR trials. Primary outcomes were changes in symptoms, 6-min walk distance, and quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) after 1 year. Secondary analyses included changes in LV structure and function. At 1 year, New York Heart Association class status was maintained (48%) or improved (46%) in most patients, mean KCCQ scores increased from baseline by 10 units [95% confidence interval (CI) 3 to17; P < 0.01] and mean 6-min walk test distance increased by 34 m (95% CI 12 to 57; P < 0.01). SMR grade improved in 25% of patients and was maintained in 58% of patients with changes in mean regurgitant volume of -7 mL (95% CI -11 to -3; P < 0.001), vena contracta -0.11 cm (95% CI -0.20 to -0.02; P < 0.05), and effective regurgitant orifice area -0.03 cm (95% CI -0.06 to -0.01; P < 0.05). There were non-significant improvements in LV ejection fraction and volumes. Survival over 1 year was 89% with no difference between mild (96%) and moderate (86%) SMR (log-rank P = 0.22). Progression-free survival was 70% (82% in mild vs. 63% in moderate SMR; P = 0.16). Freedom from HF hospitalization was 73% (87% in mild SMR vs. 66% in moderate SMR; P = 0.07).
Among patients with symptomatic HF and mild or moderate SMR on guideline-directed medical therapy, percutaneous mitral annuloplasty was associated with improvements in symptoms, SMR, a stabilization of LV structure and function, and high survival rates.
确定经皮二尖瓣环成形术对轻、中度继发性二尖瓣反流（SMR）患者症状、步行距离以及左心室（LV）结构和功能的影响。
这是一项对68例患者的汇总分析，这些患者尽管接受了指南指导的药物治疗，但仍有症状性心力衰竭（HF），伴有轻度（n = 25）或中度（n = 43）SMR，并作为TITAN、TITAN II或REDUCE - FMR试验的一部分接受了经皮二尖瓣环成形术。主要结局是1年后通过堪萨斯城心肌病问卷（KCCQ）评估的症状、6分钟步行距离和生活质量的变化。次要分析包括LV结构和功能的变化。1年后，大多数患者的纽约心脏协会心功能分级状态维持不变（48%）或有所改善（46%），KCCQ平均得分较基线提高了10分[95%置信区间（CI）3至17；P < 0.01]，6分钟步行试验平均距离增加了34米（95% CI 12至57；P < 0.01）。25%的患者SMR分级改善，58%的患者维持不变，平均反流容积变化为 -7 mL（95% CI -11至 -3；P < 0.001），反流束缩流颈 -0.11厘米（95% CI -0.20至 -0.02；P < 0.05），有效反流口面积 -0.03平方厘米（95% CI -0.06至 -0.01；P < 0.05）。LV射血分数和容积有非显著性改善。1年生存率为89%（轻度组96%，中度组86%），两组无差异（对数秩检验P = 0.22）。无进展生存率为70%（轻度组82%，中度组63%；P = 0.16）。免于HF住院的比例为73%（轻度SMR组87%，中度SMR组66%；P = 0.07）。
在接受指南指导药物治疗的有症状HF且伴有轻、中度SMR的患者中，经皮二尖瓣环成形术与症状改善、SMR改善、LV结构和功能稳定以及高生存率相关。
