Smidt Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA.
JACC Cardiovasc Interv. 2022 May 9;15(9):935-945. doi: 10.1016/j.jcin.2022.01.281. Epub 2022 Apr 13.
This study sought to evaluate the prognostic value of an increased mean mitral valve pressure gradient (MVG) in patients with primary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER).
Conflicting data exist regarding impact of increased mean MVG on outcomes after TEER.
This study included 419 patients with primary MR (mean age 80.6 ± 10.4 years; 40.6% female) who underwent TEER. Patients were divided into quartiles (Qs) based on discharge echocardiographic mean MVG. Primary outcome was the composite endpoint of all-cause mortality and heart failure hospitalization. Secondary outcomes included all-cause mortality and the secondary composite endpoint of all-cause mortality, heart failure hospitalization, and mitral valve reintervention.
The median number of MitraClips used was 2 per patient. MR reduction ≤moderate was achieved in 407 (97.1%) patients. Mean MVG was 1.9 ± 0.3 mm Hg, 3.0 ± 0.1 mm Hg, 4.0 ± 0.1 mm Hg, and 6.0 ± 1.2 mm Hg in Q1, Q2, Q3, and Q4, respectively. There was no significant differences across quartiles in the primary outcome (15.4%, 19.6%, 22.0%, and 21.9% in Q1-Q4, respectively; P = 0.63), all-cause mortality (15.9% vs 18.6% vs 19.4% vs 17.1%, respectively; P = 0.91), and the secondary composite endpoint at 2 years (33.3% vs 29.5% vs 22.0% vs 31.6%, respectively; P = 0.37). After multivariate adjustment for baseline clinical and procedural variables, the mean MVG in Q4 compared with Q1 to Q3 was not independently associated with the primary outcome (HR: 1.22; 95% CI: 0.82-1.83; P = 0.33), all-cause mortality, and the secondary composite endpoint.
Increased mean MVG was not independently associated with adverse events after TEER in patients with primary MR.
本研究旨在评估原发性二尖瓣反流（MR）患者经导管缘对缘修复（TEER）后平均二尖瓣压力梯度（MVG）升高的预后价值。
关于 TEER 后平均 MVG 升高对结局的影响存在相互矛盾的数据。
本研究纳入 419 例原发性 MR 患者（平均年龄 80.6 ± 10.4 岁；40.6%为女性），均接受 TEER 治疗。根据出院时超声心动图的平均 MVG 将患者分为四分位数（Q）。主要终点为全因死亡率和心力衰竭住院的复合终点。次要终点包括全因死亡率和全因死亡率、心力衰竭住院和二尖瓣再介入的次要复合终点。
每位患者平均使用 MitraClips 2 个。407 例（97.1%）患者的 MR 减少程度为中度以下。平均 MVG 分别为 Q1、Q2、Q3 和 Q4 的 1.9 ± 0.3mmHg、3.0 ± 0.1mmHg、4.0 ± 0.1mmHg 和 6.0 ± 1.2mmHg。在主要终点方面，四分位组之间无显著差异（Q1-Q4 分别为 15.4%、19.6%、22.0%和 21.9%；P = 0.63），全因死亡率（15.9% vs 18.6% vs 19.4% vs 17.1%；P = 0.91）和 2 年时的次要复合终点（33.3% vs 29.5% vs 22.0% vs 31.6%；P = 0.37）。在校正基线临床和程序变量后进行多变量调整，与 Q1 至 Q3 相比，Q4 的平均 MVG 与主要结局（HR：1.22；95%CI：0.82-1.83；P = 0.33）、全因死亡率和次要复合终点均无独立相关性。
原发性 MR 患者经 TEER 后，平均 MVG 升高与不良事件无独立相关性。
