Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA; Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA.
J Cardiol. 2022 Dec;80(6):563-572. doi: 10.1016/j.jjcc.2022.07.017. Epub 2022 Aug 11.
Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exist on MDCT parameters predicting residual mitral regurgitation (MR) post-MitraClip (Abbott Laboratories, Abbott Park, IL, USA).
We analyzed preprocedural MDCTs of 78 consecutive patients with secondary MR undergoing MitraClip implantation at our institution. Moderate-or-severe mitral leaflet calcification (MLC) was defined as calcification, with-or-without mitral annular calcification, extending beyond the mitral leaflet base. Residual MR was assessed by postprocedural transesophageal echocardiography, and clinical outcomes were assessed at 1-year.
Fifteen patients (19 %) had residual MR ≥2+. Compared to patients with none-or-mild residual MR, MDCT-derived mitral valve orifice area (MVOA) to mitral annulus area (MAA) ratio was significantly lower (0.32 ± 0.06 vs. 0.39 ± 0.09; p = 0.003), and the prevalence of MLC was higher (40 % vs. 18 %; p = 0.057) in those with residual MR ≥2+. Furthermore, the MVOA/MAA ratio and MLC were independent predictors of residual MR ≥2+ post-MitraClip [adjusted odds ratio (OR): 0.88 (0.80-0.97) and 5.50 (1.16-26.23), respectively]. On receiver-operating-characteristic-curve analysis, MVOA/MAA ratio <0.31 had a sensitivity of 87 % and a specificity of 60 % for residual MR ≥2+. When patients were classified according to the presence of MLC and an MVOA/MAA ratio <0.31, those with both parameters had significantly higher rates of postprocedural residual MR ≥2+ and mitral reintervention at 1-year than those with only one, and those without both parameters.
In patients with secondary MR undergoing the MitraClip procedure, preprocedural MDCT parameters, specifically MVOA/MAA ratio and MLC, are useful to predict postprocedural residual MR.
多排螺旋计算机断层扫描（MDCT）可为经导管二尖瓣介入治疗的术前规划提供有价值的信息。然而，目前尚无关于 MDCT 预测二尖瓣修复术后残余二尖瓣反流（MR）的参数。
我们分析了在我院接受二尖瓣修复术的 78 例继发性 MR 患者的术前 MDCT。中度或重度二尖瓣叶钙化（MLC）定义为伴有或不伴有二尖瓣环钙化的钙化，延伸至二尖瓣叶基底之外。术后经食管超声心动图评估残余 MR，1 年后评估临床结果。
15 例（19%）患者存在残余 MR≥2+。与无或轻度残余 MR 的患者相比，MDCT 得出的二尖瓣瓣口面积（MVOA）与二尖瓣环面积（MAA）比值明显更低（0.32±0.06 比 0.39±0.09；p=0.003），且存在 MLC 的患者比例更高（40%比 18%；p=0.057）。此外，MVOA/MAA 比值和 MLC 是二尖瓣修复术后残余 MR≥2+的独立预测因素[校正比值比（OR）：0.88（0.80-0.97）和 5.50（1.16-26.23）]。在接受者操作特征曲线分析中，MVOA/MAA 比值<0.31 的敏感度为 87%，特异性为 60%，用于预测残余 MR≥2+。当根据 MLC 存在和 MVOA/MAA 比值<0.31 对患者进行分类时，与仅存在其中一个参数的患者相比，同时存在这两个参数的患者术后残余 MR≥2+和二尖瓣再介入的发生率显著更高，而不存在这两个参数的患者发生率则较低。
在接受二尖瓣修复术的继发性 MR 患者中，术前 MDCT 参数，特别是 MVOA/MAA 比值和 MLC，可用于预测术后残余 MR。
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