Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Jacksonville, Florida, USA.
Catheter Cardiovasc Interv. 2022 Jul;100(1):133-142. doi: 10.1002/ccd.30224. Epub 2022 May 10.
Mitral transcatheter edge-to-edge repair (MTEER) is an established therapeutic approach for mitral regurgitation (MR). Functional mitral regurgitation originating from atrial myopathy (A-FMR) has been described.
We sought to assess the clinical, echocardiographic and hemodynamic considerations in A-FMR patients undergoing MTEER.
From 2014 to 2020, patients undergoing MTEER for degenerative MR (DMR), functional MR (FMR), and mixed MR were assessed. A-FMR was defined by the presence of MR > moderate in severity; left ventricular (LV) ejection fraction (LVEF) ≥ 50%; and severe left atrial (LA) enlargement in the absence of LV dysfunction, leaflet pathology, or LV tethering. The diagnosis of A-FMR (vs. ventricular-FMR [V-FMR]) was confirmed by three independent echocardiographers. Baseline characteristics, procedural outcomes as well as clinical and echocardiographic follow-up are reported. Device success was defined as final MR grade ≤ moderate; MR reduction ≥1 grade; and final transmitral gradient <5 mmHg.
306 patients underwent MTEER, including DMR (62%), FMR (19%), and mixed MR (19%). FMR cases included 37 (63.8%) V-FMR and 21 (36.2%) A-FMR. Tricuspid regurgitation (≥ moderate) was higher in A-FMR (80.1%) compared to V-FMR (54%) and DMR (42%). Device success did not significantly differ between A-FMR and V-FMR (57% vs. 73%, p = 0.34) or DMR (57% vs. 64%, p = 1.0). The A-FMR cohort was less likely to achieve ≥3 grades of MR reduction compared to V-FMR (19% vs. 54%, p = 0.01) and DMR (19% vs. 49.7%, p = 0.01). Patients with V-FMR and DMR demonstrated significant reductions in mean left atrial pressure (LAP) and peak LA V-wave, though A-FMR did not (LAP -0.24 ± 4.9, p = 0.83; peak V-wave -1.76 ± 9.1, p = 0.39). In follow-up, echocardiographic and clinical outcomes were similar.
In patients undergoing MTEER, A-FMR represents one-third of FMR cases. A-FMR demonstrates similar procedural success but blunted acute hemodynamic responses compared with DMR and V-FMR following MTEER. Dedicated studies specifically considering A-FMR are needed to discern the optimal therapeutic approaches.
二尖瓣经导管缘对缘修复术（MTEER）是治疗二尖瓣反流（MR）的一种既定治疗方法。已经描述了起源于心房心肌病（A-FMR）的功能性二尖瓣反流。
我们旨在评估接受 MTEER 的 A-FMR 患者的临床、超声心动图和血流动力学考虑因素。
从 2014 年到 2020 年，对接受退行性 MR（DMR）、功能性 MR（FMR）和混合性 MR 行 MTEER 的患者进行了评估。A-FMR 的定义是 MR 严重程度 > 中度；左心室（LV）射血分数（LVEF） ≥ 50%；并且在没有 LV 功能障碍、瓣叶病变或 LV 牵张的情况下存在严重的左心房（LA）增大。A-FMR（与心室-FMR [V-FMR]）的诊断由三名独立的超声心动图医师确认。报告了基线特征、手术结果以及临床和超声心动图随访情况。设备成功定义为最终 MR 等级 ≤ 中度；MR 降低≥1 级；和最终经二尖瓣梯度 < 5mmHg。
306 例患者接受了 MTEER 治疗，包括 DMR（62%）、FMR（19%）和混合性 MR（19%）。FMR 病例包括 37 例（63.8%）V-FMR 和 21 例（36.2%）A-FMR。A-FMR 的三尖瓣反流（≥中度）高于 V-FMR（54%）和 DMR（42%）。A-FMR 与 V-FMR（57% 与 73%，p=0.34）或 DMR（57% 与 64%，p=1.0）之间的设备成功率无显著差异。与 V-FMR（19% 与 54%，p=0.01）和 DMR（19% 与 49.7%，p=0.01）相比，A-FMR 达到≥3 级 MR 降低的可能性较小。与 V-FMR 和 DMR 相比，A-FMR 的平均左心房压（LAP）和左房峰值 V 波没有显著降低（LAP -0.24±4.9，p=0.83；峰值 V 波 -1.76±9.1，p=0.39）。在随访中，超声心动图和临床结果相似。
在接受 MTEER 的患者中，A-FMR 占 FMR 病例的三分之一。与 DMR 和 V-FMR 相比，A-FMR 在接受 MTEER 后具有相似的手术成功率，但急性血流动力学反应减弱。需要专门的研究来确定 A-FMR 的最佳治疗方法。
