Division of Cardiology, Mount Sinai Hospital, New York, New York.
Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
J Cardiovasc Med (Hagerstown). 2022 Dec 1;23(12):787-797. doi: 10.2459/JCM.0000000000001359. Epub 2022 Aug 17.
Examine the impact of acute changes in left heart strain and volumes with percutaneous edge-to-edge MitraClip repair on improvement in health status assessed using Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score.
Changes in left atrial strain, left ventricular (LV) global longitudinal strain (LVGLS), LV end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were evaluated in 50 patients undergoing MitraClip repair for symptomatic primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) on transthoracic echocardiography before and 1 month after MitraClip. Multivariable regression was used to evaluate changes in left heart strain and volumes as predictors of change in KCCQ-12 scores, adjusting for baseline clinical and echocardiographic characteristics.
Both PMR and SMR patients had significant increase in LVGLS and reduction in LVEDV and LVESV ( P < 0.05) after MitraClip, reduction trend in left atrial conduit strain (PMR P = 0.053; SMR P = 0.12) but no significant change in LV ejection fraction. KCCQ-12 score improved significantly in both PMR ( P < 0.001) and SMR cohorts ( P < 0.001). Higher delta KCCQ-12 tertiles were associated with greater reduction in LVEDV ( P = 0.022) after MitraClip. On multiple regression analysis, lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial strain conduit phase were associated with KCCQ-12 score improvement ( P < 0.001).
There is a significant increase in LVGLS and reduction in LVEDV, LVESV and left atrial strain conduit after edge-to-edge MitraClip repair in both PMR and SMR. Lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial conduit strain were associated with KCCQ-12 score improvement after MitraClip. Further studies are warranted to understand the mechanism and significance of our findings.
通过经皮缘对缘 MitraClip 修复术，观察左心应变和容积的急性变化对采用堪萨斯城心肌病问卷 12 分（KCCQ-12）评分评估的健康状况改善的影响。
对 50 例因症状性原发性二尖瓣反流（PMR）和继发性二尖瓣反流（SMR）而行 MitraClip 修复术的患者进行经胸超声心动图检查，评估左心房应变、左心室（LV）整体纵向应变（LVGLS）、LV 收缩末期容积（LVESV）和 LV 舒张末期容积（LVEDV）在 MitraClip 修复术前和术后 1 个月的变化。采用多变量回归分析，调整基线临床和超声心动图特征后，评估左心应变和容积变化作为 KCCQ-12 评分变化的预测因子。
PMR 和 SMR 患者在 MitraClip 后均有明显的 LVGLS 增加和 LVEDV 和 LVESV 减少（P<0.05），左心房导联应变呈下降趋势（PMR P=0.053；SMR P=0.12），但 LV 射血分数无明显变化。KCCQ-12 评分在 PMR 组（P<0.001）和 SMR 组（P<0.001）均显著改善。MitraClip 后 LVEDV 减少较大的患者 KCCQ-12 tertiles 较高（P=0.022）。多变量回归分析显示，术前 STS 二尖瓣置换术和 KCCQ-12 评分较低，LVESV 和左心房应变导联相减少较大与 KCCQ-12 评分改善相关（P<0.001）。
在 PMR 和 SMR 中，缘对缘 MitraClip 修复术后 LVGLS 增加，LVEDV、LVESV 和左心房应变导联相减少。术前 STS 二尖瓣置换术和 KCCQ-12 评分较低，LVESV 和左心房应变导联相减少较大与 MitraClip 后 KCCQ-12 评分改善相关。需要进一步研究以了解我们研究结果的机制和意义。
