Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany.
Department of Cardiology and Angiology, Ostalbklinikum Aalen, Aalen, Germany.
Clin Cardiol. 2023 May;46(5):529-534. doi: 10.1002/clc.24007. Epub 2023 Mar 22.
Risk stratification for transcatheter procedures in patients with severe mitral regurgitation is challenging. Deceleration capacity (DC) has already proven to be a reliable risk predictor in patients undergoing transcatheter aortic valve implantation. We hypothesized, that DC provides prognostic value in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER).
We retrospectively analyzed electrocardiogram signals from 106 patients undergoing TEER at the University Hospital of Tübingen. All patients received continuous heart-rate monitoring to assess DC following the procedure. One-year all-cause mortality was defined as the primary end point.
Sixteen patients (15.1%) died within 1 year. The DC in nonsurvivors was significantly reduced compared to survivors (5.1 ± 3.0 vs. 3.0 ± 1.6 ms, p = 0.002). A higher EuroSCORE II and impaired left ventricular function were furthermore associated with poor outcome. In Cox regression analyses, a DC < 4.5 ms was found a strong predictor of 1-year mortality (hazard ratio: 0.10, 95% confidence interval: 0.13-0.79, p = 0.029). Finally, a significant negative correlation was found between DC and residual mitral regurgitation after TEER (r = -0.41, p < 0.001).
In patients with severe mitral regurgitation undergoing TEER, DC may serve as a new predictor of follow-up mortality.
严重二尖瓣反流患者行经导管介入治疗的风险分层具有挑战性。减速能力（DC）已被证明是行经导管主动脉瓣植入术患者的可靠风险预测因子。我们假设，DC 可为行经导管缘对缘二尖瓣修复术（TEER）的患者提供预后价值。
我们回顾性分析了在图宾根大学医院接受 TEER 的 106 例患者的心电图信号。所有患者均接受连续心率监测，以评估术后的 DC。一年全因死亡率定义为主要终点。
16 例患者（15.1%）在 1 年内死亡。与存活者相比，非幸存者的 DC 明显降低（5.1±3.0 比 3.0±1.6 ms，p=0.002）。较高的 EuroSCORE II 和受损的左心室功能也与不良结局相关。在 Cox 回归分析中，DC<4.5 ms 是 1 年死亡率的强烈预测因子（危险比：0.10，95%置信区间：0.13-0.79，p=0.029）。最后，TEER 后 DC 与残余二尖瓣反流之间存在显著负相关（r=-0.41，p<0.001）。
在接受 TEER 的严重二尖瓣反流患者中，DC 可能成为随访死亡率的新预测因子。
