二尖瓣反流的瓣对瓣修复对左心力学和健康状况的急性影响。

Acute effect of edge-to-edge repair of mitral regurgitation on left heart mechanics and health status.

机构信息

Division of Cardiology, Mount Sinai Hospital, New York, New York.

Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.

出版信息

J Cardiovasc Med (Hagerstown). 2022 Dec 1;23(12):787-797. doi: 10.2459/JCM.0000000000001359. Epub 2022 Aug 17.

DOI:10.2459/JCM.0000000000001359

PMID:36166336

Abstract

AIMS

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

摘要

目的

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。

方法

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。

结果

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）。

结论

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。