经导管缘对缘修复术后三尖瓣梯度的预后价值：来自TriValve注册研究的见解
Prognostic Value of Tricuspid Valve Gradient After Transcatheter Edge-to-Edge Repair: Insights From the TriValve Registry.
作者信息
Coisne Augustin, Scotti Andrea, Taramasso Maurizio, Granada Juan F, Ludwig Sebastian, Rodés-Cabau Josep, Lurz Philipp, Hausleiter Jörg, Fam Neil, Kodali Susheel K, Pozzoli Alberto, Alessandrini Hannes, Biasco Luigi, Brochet Eric, Denti Paolo, Estevez-Loureiro Rodrigo, Frerker Christian, Ho Edwin C, Monivas Vanessa, Nickenig Georg, Praz Fabien, Puri Rishi, Sievert Horst, Tang Gilbert H L, Andreas Martin, Von Bardeleben Ralph Stephan, Rommel Karl-Philipp, Muntané-Carol Guillem, Gavazzoni Mara, Braun Daniel, Lubos Edith, Kalbacher Daniel, Connelly Kim A, Juliard Jean-Michel, Harr Claudia, Pedrazzini Giovanni, Philippon François, Schofer Joachim, Thiele Holger, Unterhuber Matthias, Himbert Dominique, Alcázar Marina Ureña, Wild Mirjam G, Jorde Ulrich, Windecker Stephan, Maisano Francesco, Leon Martin B, Hahn Rebecca T, Latib Azeem
机构信息
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Universitè Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France.
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
出版信息
JACC Cardiovasc Interv. 2023 Mar 10. doi: 10.1016/j.jcin.2023.01.375.
BACKGROUND
Data regarding the impact of the tricuspid valve gradient (TVG) after tricuspid transcatheter edge-to-edge repair (TEER) are scarce.
OBJECTIVES
This study sought to evaluate the association between the mean TVG and clinical outcomes among patients who underwent tricuspid TEER for significant tricuspid regurgitation.
METHODS
Patients with significant tricuspid regurgitation who underwent tricuspid TEER within the TriValve (International Multisite Transcatheter Tricuspid Valve Therapies) registry were divided into quartiles based on the mean TVG at discharge. The primary endpoint was the composite of all-cause mortality and heart failure hospitalization. Outcomes were assessed up to the 1-year follow-up.
RESULTS
A total of 308 patients were included from 24 centers. Patients were divided into quartiles of the mean TVG as follows: quartile 1 (n = 77), 0.9 ± 0.3 mm Hg; quartile 2 (n = 115), 1.8 ± 0.3 mm Hg; quartile 3 (n = 65), 2.8 ± 0.3 mm Hg; and quartile 4 (n = 51), 4.7 ± 2.0 mm Hg. The baseline TVG and the number of implanted clips were associated with a higher post-TEER TVG. There was no significant difference across TVG quartiles in the 1-year composite endpoint (quartiles 1-4: 35%, 30%, 40%, and 34%, respectively; P = 0.60) or the proportion of patients in New York Heart Association class III to IV at the last follow-up (P = 0.63). The results were similar after adjustment for clinical and echocardiographic characteristics (composite endpoint quartile 4 vs quartile 1-quartile 3 adjusted HR: 1.05; 95% CI: 0.52-2.12; P = 0.88) or exploring post-TEER TVG as a continuous variable.
CONCLUSIONS
In this retrospective analysis of the TriValve registry, an increased discharge TVG was not significantly associated with adverse outcomes after tricuspid TEER. These findings apply for the explored TVG range and up to the 1-year follow-up. Further investigations on higher gradients and longer follow-up are needed to better guide the intraprocedural decision-making process.
背景
关于经导管三尖瓣缘对缘修复术（TEER）后三尖瓣梯度（TVG）影响的数据稀缺。
目的
本研究旨在评估因严重三尖瓣反流接受三尖瓣TEER的患者中，平均TVG与临床结局之间的关联。
方法
在TriValve（国际多中心经导管三尖瓣治疗）注册研究中接受三尖瓣TEER的严重三尖瓣反流患者，根据出院时的平均TVG分为四分位数。主要终点是全因死亡率和心力衰竭住院的复合终点。随访1年评估结局。
结果
共纳入来自24个中心的308例患者。患者按平均TVG四分位数分组如下：第一四分位数（n = 77），0.9±0.3 mmHg；第二四分位数（n = 115），1.8±0.3 mmHg；第三四分位数（n = 65），2.8±0.3 mmHg；第四四分位数（n = 51），4.7±2.0 mmHg。基线TVG和植入夹子数量与TEER术后较高的TVG相关。TVG四分位数在1年复合终点（四分位数1 - 4分别为：35%、30%、40%和34%；P = 0.60）或最后随访时纽约心脏协会III - IV级患者比例方面无显著差异（P = 0.63）。在对临床和超声心动图特征进行调整后（复合终点第四四分位数与第一 - 第三四分位数调整后HR：1.05；95%CI：0.52 - 2.12；P = 0.88），或将TEER术后TVG作为连续变量进行分析时，结果相似。
结论
在对TriValve注册研究的这项回顾性分析中，三尖瓣TEER术后出院时TVG升高与不良结局无显著关联。这些发现适用于所探索的TVG范围及长达1年的随访。需要对更高梯度和更长随访时间进行进一步研究，以更好地指导术中决策过程。
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