Tehrani David M, Wang Jiexi, Lai Parntip, Desai Pooja S, Nguyen Heajung L, Bang Lisa, Yang Eric H, Vorobiof Gabriel, Nsair Ali, Aksoy Olcay, Press Marcella Calfon, Parikh Rushi V
Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
These authors contributed equally to this article.
Cardiol Res. 2021 Oct;12(5):302-308. doi: 10.14740/cr1284. Epub 2021 Jul 28.
Pre-existing pulmonary hypertension is associated with poor outcomes after transcatheter mitral valve repair (TMVr) for mitral regurgitation (MR). However, the impact of an immediate change in mean pulmonary artery pressure (ΔmPAP) following TMVr on outcomes is unknown.
Patients who underwent TMVr from December 2015 to February 18, 2020 at our institution for symptomatic 3-4+ MR and who had invasive hemodynamics measured immediately pre- and post-TMVR were included. Multivariate Cox regression analysis was performed to examine the association of ΔmPAP (post-TMVr - pre-TMVr mPAP) with the primary endpoint of heart failure (HF) readmission at 1 year. Secondary endpoints included all-cause mortality and the composite endpoint of HF readmission or all-cause mortality at 1 year.
Among 55 patients, 55% were men, mean age was 72 ± 14.2 years, and mean ΔmPAP was -1.4 ± 8.2 mm Hg. Overall, HF readmission occurred in 14 (25%), death in 10 (18%), and the composite endpoint in 20 (36%) patients. In multivariable analyses, higher ΔmPAP was significantly associated with HF readmission (hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.00 - 1.21; P = 0.04). ΔmPAP was not associated with death (HR = 1.04, 95% CI: 0.96 - 1.14; P = 0.33), though there was a numerical but statistically non-significant trend towards the composite endpoint (HR = 1.06, 95% CI: 1.00 - 1.13; P = 0.06) driven by HF readmission.
Higher ΔmPAP immediately following TMVr was associated with increased HF readmission at 1 year. Larger prospective studies are needed to validate these data and further explore the utility of ΔmPAP as a novel hemodynamic parameter to predict post-TMVR outcomes.
既往存在的肺动脉高压与经导管二尖瓣修复术（TMVr）治疗二尖瓣反流（MR）后的不良预后相关。然而，TMVr后平均肺动脉压的即刻变化（ΔmPAP）对预后的影响尚不清楚。
纳入2015年12月至2020年2月18日在我院因有症状的3-4+级MR接受TMVr且在TMVr前后即刻进行有创血流动力学测量的患者。进行多变量Cox回归分析，以检验ΔmPAP（TMVr后 - TMVr前mPAP）与1年内心力衰竭（HF）再入院这一主要终点的相关性。次要终点包括全因死亡率以及1年内心力衰竭再入院或全因死亡率的复合终点。
55例患者中，55%为男性，平均年龄为72±14.2岁，平均ΔmPAP为-1.4±8.2 mmHg。总体而言，14例（25%）患者发生HF再入院，10例（18%）患者死亡，20例（36%）患者达到复合终点。在多变量分析中，较高的ΔmPAP与HF再入院显著相关（风险比（HR）=1.10，95%置信区间（CI）：1.00 - 1.21；P = 0.04）。ΔmPAP与死亡无关（HR = 1.04，95% CI：0.96 - 1.14；P = 0.33），尽管受HF再入院影响，在复合终点方面有数值上但无统计学意义的趋势（HR = 1.06，95% CI：1.00 - 1.13；P = 0.06）。
TMVr后即刻较高的ΔmPAP与1年内心力衰竭再入院增加相关。需要更大规模的前瞻性研究来验证这些数据，并进一步探索ΔmPAP作为预测TMVr后预后的新型血流动力学参数的效用。
