Pozo Osinalde Eduardo, Salinas Gallegos Alejandra, Gordillo Ximena, Nombela Franco Luis, Marcos-Alberca Pedro, Mahía Patricia, Tirado-Conte Gabriela, Gómez de Diego José Juan, Jiménez Quevedo Pilar, Fernández-Ortíz Antonio, Pérez-Villacastín Julián, de Agustín Loeches Jose Alberto
Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain.
Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain.
J Clin Med. 2022 Apr 19;11(9):2276. doi: 10.3390/jcm11092276.
Background: There is no consensus on the best intraprocedural parameter to evaluate residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair (TEER). Thus, our aim was to evaluate the predictive value of different MR parameters from intraprocedural transesophageal echocardiogram (TEE) for grading in consecutive transthoracic echocardiogram (TTE) during the follow up. Methods: All the consecutive patients who underwent TEER with MitraClip between 2010 and 2020 in our center were considered. TEE-derived immediate postprocedural MR parameters were reassessed to blindly compare them with follow up MR grading in sequential TTE. Results: We finally included 88 patients (64.8% males; 76 ± 10 years-old). Significant MR was detected in 14.3% of the cases at 6 months, in similar proportion than at postprocedural at 1 month. Among all the intraprocedural TEE quantitative parameters only additive and maximum VC were associated with significant MR persistence. Moreover, on ROC analysis maximum VC demonstrated an excellent discriminatory power (AUC 0.96; p < 0.001) to identify MR ≥ III at 6 months. Thus, a cut-off point of 0.45 cm demonstrated 88% sensitivity and 89% specificity. Conclusion: Among intraprocedural TEE parameters to evaluate residual MR in TEER, maximum and additive VC were the most reliable to predict persistence of significant insufficiency.
对于经导管二尖瓣缘对缘修复术（TEER）后评估残余二尖瓣反流（MR）的最佳术中参数尚无共识。因此，我们的目的是评估术中经食管超声心动图（TEE）不同MR参数对随访期间连续经胸超声心动图（TTE）分级的预测价值。方法：纳入2010年至2020年在本中心接受MitraClip TEER治疗的所有连续患者。重新评估TEE得出的术后即刻MR参数，以将其与序贯TTE中的随访MR分级进行盲法比较。结果：我们最终纳入了88例患者（男性占64.8%；年龄76±10岁）。6个月时14.3%的病例检测到显著MR，比例与术后1个月时相似。在所有术中TEE定量参数中，只有相加性和最大反流口面积（VC）与显著MR持续存在相关。此外，在ROC分析中，最大VC对识别6个月时MR≥III级具有出色的鉴别能力（AUC 0.96；p<0.001）。因此，0.45 cm的截断点显示出88%的敏感性和89%的特异性。结论：在评估TEER中残余MR的术中TEE参数中，最大和相加性VC是预测显著反流持续存在最可靠的参数。
