Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy.
Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - S. Marco," University of Catania, Italy.
Am J Cardiol. 2022 Nov 1;182:46-54. doi: 10.1016/j.amjcard.2022.07.036. Epub 2022 Sep 6.
Despite being highly effective in reducing residual mitral regurgitation and improving outcomes, mitral valve transcatheter edge-to-edge repair (MV-TEER) may be associated with high postprocedural residual mitral gradient (rMG). Conflicting results have been reported regarding the relation between rMG and adverse events. This study aimed to evaluate the predictors and the impact of elevated rMG after MV-TEER on clinical events in patients with functional mitral regurgitation (FMR) at 2 years follow-up. We selected a cohort of 864 patients with FMR who were treated with MV-TEER enrolled in the multicentre Italian Society of Interventional Cardiology (GISE) registry of transcatheter treatment of mitral valve regurgitation (GIOTTO). Patients were stratified into tertiles according to rMG. The primary clinical end point was a composite of all-cause death and hospitalization because of heart failure at 2-year follow-up. Overall, 269 patients (31.5%) with an rMG <3 mm Hg, 259 (30.3%) with an rMG ≥3/<4 mm Hg, and 326 (38.2%) with an rMG ≥4 mm Hg were considered. At multivariate logistic regression, ischemic FMR etiology, baseline MG, and the number of implanted clips were independent predictors of an rMG ≥4 mm Hg. Clinical follow-up was available in 570 patients (63.2%). Patients with an rMG ≥4 mm Hg experienced higher rates of the composite end point than patients of the other tertiles (51.1%, vs 42.3% vs 40.8% log-rank test: p = 0.033). In multivariate Cox's regression, both rMG ≥4 mm Hg (hazard ratio 1.54, 95% confidence interval 1.14 to 2.08) and residual mitral regurgitation ≥2+ (hazard ratio 1.36, 95% confidence interval 1.01 to 1.83) were independent predictors of adverse events at 2-year follow-up. In conclusion, we demonstrated that real-world patients who underwent MV-TEER who show an rMG ≥4 mm Hg are at higher risk of death or hospitalization because of heart failure during a 2-year follow-up. Further studies will be needed to confirm our results.
尽管经导管二尖瓣缘对缘修复术（MV-TEER）在降低残余二尖瓣反流和改善预后方面非常有效，但可能与术后残余二尖瓣梯度（rMG）升高有关。关于 rMG 与不良事件之间的关系，已有相互矛盾的结果报告。本研究旨在评估 MV-TEER 后 rMG 升高对功能性二尖瓣反流（FMR）患者 2 年随访时临床事件的预测因素和影响。我们选择了 864 例 FMR 患者的队列，这些患者在意大利介入心脏病学会（GISE）的多中心经导管二尖瓣反流治疗注册研究（GIOTTO）中接受了 MV-TEER 治疗。根据 rMG 将患者分为三分位。主要临床终点是 2 年随访时全因死亡和因心力衰竭住院的复合终点。总体而言，269 例患者（31.5%）rMG <3mmHg，259 例患者（30.3%）rMG≥3/<4mmHg，326 例患者（38.2%）rMG≥4mmHg。多变量逻辑回归分析显示，缺血性 FMR 病因、基线 MG 和植入夹的数量是 rMG≥4mmHg 的独立预测因素。570 例患者（63.2%）有临床随访。rMG≥4mmHg 的患者复合终点发生率高于其他两个三分位数的患者（51.1%、42.3%、40.8%，对数秩检验：p=0.033）。多变量 Cox 回归分析显示，rMG≥4mmHg（风险比 1.54，95%置信区间 1.14 至 2.08）和残余二尖瓣反流≥2+（风险比 1.36，95%置信区间 1.01 至 1.83）均为 2 年随访时不良事件的独立预测因素。总之，我们证明了在真实世界中，接受 MV-TEER 治疗的患者，如果 rMG≥4mmHg，在 2 年随访期间因心力衰竭死亡或住院的风险更高。需要进一步的研究来证实我们的结果。
