Lugo-Fagundo Nahyr, Pierre Keniel, Adedinsewo Demilade, Simard Trevor, Alkhouli Mohamad, Eleid Mackram F, Rihal Charanjit S, Guerrero Mayra, El Sabbagh Abdallah
Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2023 Feb;101(3):605-609. doi: 10.1002/ccd.30577. Epub 2023 Jan 30.
Elevated transmitral gradient post transcatheter mitral valve edge-to-edge repair (TEER) has been associated with worse outcomes. Whether an elevated baseline transmitral diastolic mean gradient (MG) ≥5 mmHg is associated with hemodynamic outcomes after TEER is unknown.
A total of 164 consecutive patients undergoing TEER at Mayo Clinic between June 2014 and May 2018 were analyzed in this retrospective study. Baseline demographics, as well as clinical, echocardiographic, and procedural data were obtained. Data on direct left atrial pressure (LAP) before and after TEER were recorded. Logistic regression models were constructed to evaluate the association between preprocedure transmitral diastolic mean gradient (pre-MG) and (1) improvement in LAP following TEER, (2) postprocedure transmitral diastolic mean gradient (post-MG). A decrease in LAP post TEER was considered an improvement in hemodynamic response. Pre-MG was categorized as: ≥5 and <5 mmHg.
Median age of the cohort was 81.5 years (Q1: 76.3, Q3: 87) and 34% were female. At baseline, median transmitral diastolic MG was 4 mmHg (Q1: 3, Q3: 5) and median LAP was 19 mmHg (Q1:16, Q3: 23.5). In a multivariable model, adjusted for age and sex, patients with pre-MG ≥ 5 mmHg were less likely to see an improvement in LAP post TEER (adjusted odds ratio [aOR]: 0.22, 95% confidence interval [CI]: 0.09, 0.55; p = 0.001) and more likely to have elevated post-MG (aOR; 7.08, 95% CI: 2.93, 17.13; p < 0.001).
Higher pre-MG (≥5 mmHg) was associated with a lower reduction in LAP and higher residual transmitral gradient following TEER suggesting other potential contributors to increased LAP besides mitral regurgitation as a cause of elevated baseline MG.
经导管二尖瓣缘对缘修复术（TEER）后二尖瓣跨瓣压差升高与预后较差相关。基线二尖瓣舒张期平均压差（MG）≥5 mmHg是否与TEER后的血流动力学结果相关尚不清楚。
本回顾性研究分析了2014年6月至2018年5月在梅奥诊所连续接受TEER的164例患者。收集了基线人口统计学资料以及临床、超声心动图和手术数据。记录了TEER前后的直接左心房压力（LAP）数据。构建逻辑回归模型以评估术前二尖瓣舒张期平均压差（术前MG）与以下因素之间的关联：（1）TEER后LAP的改善情况；（2）术后二尖瓣舒张期平均压差（术后MG）。TEER后LAP降低被认为是血流动力学反应的改善。术前MG分为：≥5 mmHg和<5 mmHg。
该队列的中位年龄为81.5岁（第一四分位数：76.3，第三四分位数：87），34%为女性。基线时，二尖瓣舒张期MG的中位数为4 mmHg（第一四分位数：3，第三四分位数：5），LAP的中位数为19 mmHg（第一四分位数：16，第三四分位数：23.5）。在一个多变量模型中，对年龄和性别进行校正后，术前MG≥5 mmHg的患者TEER后LAP改善的可能性较小（校正比值比[aOR]：0.22，95%置信区间[CI]：0.09，0.55；p = 0.001），术后MG升高的可能性较大（aOR；7.08，95% CI：2.93，17.13；p < 0.001）。
较高的术前MG（≥5 mmHg）与TEER后LAP降低幅度较小以及较高的残余二尖瓣压差相关，这表明除二尖瓣反流作为基线MG升高的原因外，还有其他潜在因素导致LAP升高。
