Doldi Philipp M, Stolz Lukas, Kalbacher Daniel, Köll Benedikt, Geyer Martin, Ludwig Sebastian, Orban Mathias, Braun Daniel, Weckbach Ludwig T, Stocker Thomas J, Näbauer Michael, Higuchi Satoshi, Ruf Tobias, Da Rocha E Silva Jaqueline, Wild Mirjam, Tence Noemie, Unterhuber Matthias, Schofer Niklas, Petrescu Aniela, Thiele Holger, Lurz Philipp, Lubos Edith, von Bardeleben Stephan, Karam Nicole, Samim Daryoush, Paradis Jean-Michel, Iliadis Christos, Xhepa Erion, Hagl Christian, Massberg Steffen, Hausleiter Jörg
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
Eur J Heart Fail. 2022 Nov;24(11):2162-2171. doi: 10.1002/ejhf.2661. Epub 2022 Sep 15.
Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality.
This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47-3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR ≤2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class ≤II) were lower in PMR patients with RVD (MR ≤2+: 82% vs. 93%, p = 0.002; NYHA class ≤II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001).
Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations.
右心室功能障碍（RVD），以右心室与肺动脉耦合来表示，最近已被确定为继发性二尖瓣反流（MR）患者接受二尖瓣缘对缘修复（M-TEER）的一个强有力的预后预测指标。本研究的目的是明确原发性MR（PMR）患者接受M-TEER时的RVD情况，并评估其对手术中MR降低、症状发展和2年全因死亡率的影响。
这项多中心研究纳入了在9个国际中心接受有症状PMR的M-TEER治疗的患者。研究队列分为推导队列（DC）和验证队列（VC），用于计算和验证RVD的最佳鉴别值。共有648例PMR患者纳入本研究。DC和VC在手术成功率和随访结果方面具有可比性。敏感性分析确定RVD是DC中2年死亡率的独立预测因素（风险比[HR]2.37，95%置信区间[CI]1.47-3.81，p<0.001），这在VC中得到证实（HR 2.06，95%CI 1.36-3.13，p<0.001）。有RVD的PMR患者手术成功率（MR≤2+）和随访时症状改善情况（纽约心脏协会[NYHA]分级≤II级）较低（MR≤2+：82%对93%，p=0.002；NYHA分级≤II级：57.3%对66.5%，有RVD与无RVD相比，p=0.09）。在所有PMR患者中，RVD 的存在显著损害了M-TEER术后的2年生存率（HR 2.23，95%CI 1.63-3.05，p<0.001）。
二尖瓣缘对缘修复是PMR患者的一种有效治疗选择。RVD的存在与MR降低较少、症状改善较少和2年死亡率增加有关。因此，RVD可能应纳入术前预后考虑因素。
