Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
JACC Cardiovasc Interv. 2022 Sep 12;15(17):1697-1707. doi: 10.1016/j.jcin.2022.06.020. Epub 2022 Aug 17.
Prediction of the clinical response to transcatheter edge-to-edge repair (TEER) remains a vexing challenge.
This study sought to examine the relation between hemodynamic profiles and outcomes following mitral TEER.
Among 378 patients (median age 82 years; 43.9% women), 3 hemodynamic profiles using residual left atrial pressure (LAP) and mitral regurgitation (MR) were defined: type I (optimal), grade ≤1 MR and mean LAP (mLAP) ≤15 mm Hg; type II (mixed), MR grade >1 or mLAP >15 mm Hg; and type III (poor), MR grade >1 and mLAP >15 mm Hg. The discrimination of these profiles for predicting outcomes was examined. A positive clinical response to TEER was defined as improvement in New York Heart Association functional class ≥I grade at 1 year without heart failure rehospitalization or death.
There were 148 (39.0%) patients classified as optimal (type I), 187 (49.0%) patients as mixed (type II), and 43 (11.0%) patients as poor (type III). For all-cause mortality, survival at 1 year was 91.6%, 82.6%, and 67.9% for types I, II, and III, respectively (HR: 2.13; 95% CI: 1.44-3.15; P < 0.001). For the composite endpoint of all-cause mortality and rehospitalization for heart failure, event-free survival at 1 year was 84.1%, 70.7%, and 53.2% for types I, II, and III, respectively (HR: 1.93; 95% CI: 1.41-2.65; P < 0.001). Hemodynamic profiling was strongly associated with a positive response to TEER, occurring in 73.9%, 57.0%, 35.0%, for types I, II, and III, respectively (P < 0.001).
In patients undergoing mitral TEER, hemodynamic profiling is prognostic, with superior survival occurring among patients with optimal reduction in MR and normal postprocedural LAP.
经导管缘对缘修复（TEER）的临床疗效预测仍然是一个棘手的挑战。
本研究旨在探讨二尖瓣 TEER 后血流动力学特征与结局的关系。
在 378 例患者（中位年龄 82 岁，43.9%为女性）中，根据残余左心房压（LAP）和二尖瓣反流（MR）定义了 3 种血流动力学特征：I 型（最佳），MR 分级≤1 级，平均 LAP（mLAP）≤15mmHg；II 型（混合），MR 分级>1 级或 mLAP>15mmHg；III 型（较差），MR 分级>1 级且 mLAP>15mmHg。研究检测了这些特征对预测结局的区分能力。TEER 后的阳性临床反应定义为 1 年时纽约心脏协会心功能分级改善≥I 级，且无心力衰竭再住院或死亡。
148 例（39.0%）患者为最佳（I 型），187 例（49.0%）为混合（II 型），43 例（11.0%）为较差（III 型）。全因死亡率方面，I、II 和 III 型患者 1 年生存率分别为 91.6%、82.6%和 67.9%（HR：2.13；95%CI：1.44-3.15；P<0.001）。全因死亡率和心力衰竭再住院的复合终点方面，I、II 和 III 型患者 1 年无事件生存率分别为 84.1%、70.7%和 53.2%（HR：1.93；95%CI：1.41-2.65；P<0.001）。血流动力学特征与 TEER 后的阳性反应密切相关，I、II 和 III 型患者阳性反应发生率分别为 73.9%、57.0%和 35.0%（P<0.001）。
在接受二尖瓣 TEER 的患者中，血流动力学特征具有预后价值，MR 显著减轻且术后 LAP 正常的患者生存情况更好。
