Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 1, 27100 Pavia, Italy.
University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Eur Heart J Acute Cardiovasc Care. 2022 Jun 22;11(6):464-469. doi: 10.1093/ehjacc/zuac053.
The effectiveness of transcatheter edge-to-edge repair (TEER) in patients with functional mitral regurgitation (FMR) and pulmonary hypertension (PH) is still debated and pre-procedural predictors of haemodynamic improvement after TEER in this setting are currently unknown. We investigated whether normalization of pulmonary artery wedge pressure (PAWP) in response to sodium nitroprusside (SNP) during baseline right heart catheterization might be predictive of a favourable haemodynamic response to MitraClip in patients with FMR and PH. Among 22 patients enrolled, 13 had a positive response to SNP (responders), nine were non-responders. At 6-months follow-up, responders showed a 33% reduction in PAWP and a 25% reduction in mean pulmonary artery pressure (PAP) (P = 0.002 and 0.004, respectively); no significant change occurred in non-responders. In patients with FMR and PH, pre-procedural vasodilator challenge with SNP may help define patients who may have haemodynamic improvement after TEER.
经导管缘对缘修复术（TEER）治疗功能性二尖瓣反流（FMR）合并肺动脉高压（PH）的疗效仍存在争议，目前尚不清楚该情况下 TEER 后血流动力学改善的术前预测因素。我们研究了在基线右心导管检查期间对硝普钠（SNP）的反应中肺动脉楔压（PAWP）是否正常，是否可以预测 FMR 合并 PH 患者对 MitraClip 的有利血流动力学反应。在纳入的 22 名患者中，13 名对 SNP 有阳性反应（应答者），9 名无应答者。在 6 个月随访时，应答者的 PAWP 降低了 33%，平均肺动脉压（PAP）降低了 25%（P 值分别为 0.002 和 0.004）；无应答者无明显变化。在 FMR 合并 PH 的患者中，用 SNP 进行术前血管扩张剂挑战可能有助于确定 TEER 后血流动力学改善的患者。
