继发性二尖瓣反流经导管缘对缘修复术后右心室与肺动脉耦合的变化
Changes in Right Ventricular-to-Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation.
作者信息
Adamo Marianna, Inciardi Riccardo Maria, Tomasoni Daniela, Dallapellegrina Lucia, Estévez-Loureiro Rodrigo, Stolfo Davide, Lupi Laura, Pancaldi Edoardo, Popolo Rubbio Antonio, Giannini Cristina, Benito-González Tomás, Fernández-Vázquez Felipe, Caneiro-Queija Berenice, Godino Cosmo, Munafò Andrea, Pascual Isaac, Avanzas Pablo, Frea Simone, Boretto Paolo, Moñivas Palomero Vanessa, Del Trigo Maria, Biagini Elena, Berardini Alessandra, Nombela-Franco Luis, Jimenez-Quevedo Pilar, Lipsic Erik, Saia Francesco, Petronio Anna Sonia, Bedogni Francesco, Sinagra Gianfranco, Guazzi Marco, Voors Adriaan, Metra Marco
机构信息
Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy.
Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain.
出版信息
JACC Cardiovasc Imaging. 2022 Dec;15(12):2038-2047. doi: 10.1016/j.jcmg.2022.08.012. Epub 2022 Oct 19.
BACKGROUND
Preprocedural right ventricular-to-pulmonary artery (RV-PA) coupling is a major predictor of outcome in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, clinical significance of changes in RV-PA coupling after M-TEER is unknown.
OBJECTIVES
The aim of this study was to evaluate changes in RV-PA coupling after M-TEER, their prognostic value, and predictors of improvement.
METHODS
This was a retrospective observational study, including patients undergoing successful M-TEER (residual mitral regurgitation ≤2+ at discharge) for SMR at 13 European centers and with complete echocardiographic data at baseline and short-term follow-up (30-180 days). RV-PA coupling was assessed with the use of echocardiography as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). All-cause death was assessed at the longest available follow-up starting from the time of the echocardiographic reassessment.
RESULTS
Among 501 patients included, 331 (66%) improved their TAPSE/PASP after M-TEER (responders) at short-term follow-up (median: 89 days; IQR: 43-159 days), whereas 170 (34%) did not (nonresponders). Lack of previous cardiac surgery, low postprocedural mitral mean gradient, low baseline TAPSE, high baseline PASP, and baseline tricuspid regurgitation were independently associated with TAPSE/PASP improvement after M-TEER. Compared with nonresponders, responders had lower New York Heart Association functional class and less heart failure hospitalizations at short-term follow-up. Improvement in TAPSE/PASP was independently associated with reduced risk of mortality at long-term follow-up (584 days; IQR: 191-1,243 days) (HR: 0.65 [95% CI: 0.42-0.92]; P = 0.017).
CONCLUSIONS
In patients with SMR, improvement in TAPSE/PASP after successful M-TEER is predicted by baseline clinical and echocardiographic variables and postprocedural mitral gradient, and is associated with a better outcome.
背景
术前右心室与肺动脉（RV-PA）耦合是接受经导管二尖瓣缘对缘修复术（M-TEER）的继发性二尖瓣反流（SMR）患者预后的主要预测指标。然而，M-TEER术后RV-PA耦合变化的临床意义尚不清楚。
目的
本研究旨在评估M-TEER术后RV-PA耦合的变化、其预后价值以及改善的预测因素。
方法
这是一项回顾性观察研究，纳入了在13个欧洲中心因SMR接受成功M-TEER（出院时残余二尖瓣反流≤2+）且在基线和短期随访（30-180天）时有完整超声心动图数据的患者。使用超声心动图评估RV-PA耦合，以三尖瓣环平面收缩期位移与肺动脉收缩压之比（TAPSE/PASP）表示。从超声心动图重新评估时间开始，在最长可用随访期评估全因死亡情况。
结果
在纳入的501例患者中，331例（66%）在M-TEER术后短期随访（中位时间：89天；四分位间距：43-159天）时TAPSE/PASP有所改善（反应者），而170例（34%）未改善（无反应者）。既往未行心脏手术、术后二尖瓣平均压差低、基线TAPSE低、基线PASP高以及基线三尖瓣反流与M-TEER术后TAPSE/PASP改善独立相关。与无反应者相比，反应者在短期随访时纽约心脏协会功能分级较低，心力衰竭住院次数较少。TAPSE/PASP改善与长期随访（584天；四分位间距：191-1243天）时死亡风险降低独立相关（HR：0.65[95%CI：0.42-0.92]；P=0.017）。
结论
在SMR患者中，成功M-TEER术后TAPSE/PASP的改善可由基线临床和超声心动图变量以及术后二尖瓣压差预测，且与更好的预后相关。
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