房间隔二尖瓣反流：经导管二尖瓣瓣环成形术治疗的特征和结局。
Atrial mitral regurgitation: Characteristics and outcomes of transcatheter mitral valve edge-to-edge repair.
机构信息
Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic School of Medicine, Jacksonville, Florida, USA.
出版信息
Catheter Cardiovasc Interv. 2022 Jul;100(1):133-142. doi: 10.1002/ccd.30224. Epub 2022 May 10.
BACKGROUND
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.
OBJECTIVES
We sought to assess the clinical, echocardiographic and hemodynamic considerations in A-FMR patients undergoing MTEER.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
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。
目的
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。
方法
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。
结果
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。
结论
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。
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