Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Am J Cardiol. 2023 Sep 15;203:265-273. doi: 10.1016/j.amjcard.2023.07.016. Epub 2023 Jul 27.
Current guidelines, supported by limited data, prioritize the use of cardiac resynchronization therapy (CRT) over mitral transcatheter edge-to-edge repair (TEER) in eligible patients. To examine TEER results and outcomes in CRT-eligible patients with functional mitral regurgitation (MR) according to CRT status, we conducted a single-center, retrospective analysis of 126 consecutive patients who underwent TEER while fulfilling guideline criteria for CRT before the procedure. The primary outcome was the composite of all-cause mortality or heart failure hospitalizations at 1 year. The secondary outcomes included individual components of the primary outcome, as well as 1-year all-cause hospitalizations and 1-month MR severity, indexed left atrial volume, and indexed left ventricular mass by echocardiography. A total of 70 patients (56%) did not undergo CRT at the time of TEER. The baseline characteristics and procedural results were mostly comparable between those with and without CRT. The no-CRT group experienced higher rates of the primary outcome (43% vs 25%, p = 0.041), which were accounted for by increased mortality (26% vs 11%, p = 0.033). After multivariable analysis, the absence of CRT was associated with more than twice the risk for the primary outcome (hazard ratio 2.36, 95% confidence interval 1.1 to 4.98, p = 0.0.017), a finding which was confined to patients with a class I indication for the device. Rates of secondary endpoints did not differ between the groups. In conclusion, in CRT-eligible patients who underwent TEER for functional MR, the 1-year clinical outcome was more favorable when the procedure was preceded by CRT.
目前的指南，基于有限的数据，优先考虑在符合条件的患者中使用心脏再同步治疗（CRT）而非经导管二尖瓣缘对缘修复（TEER）。为了根据 CRT 状态检查 CRT 适应证患者中功能性二尖瓣反流（MR）的 TEER 结果和结局，我们对 126 例连续患者进行了单中心回顾性分析，这些患者在进行 TEER 前符合 CRT 指南标准。主要结局是 1 年时全因死亡率或心力衰竭住院的复合终点。次要结局包括主要结局的各个组成部分，以及 1 年全因住院率和 1 个月时的 MR 严重程度、超声心动图左心房容积指数和左心室质量指数。共有 70 例（56%）患者在 TEER 时未接受 CRT。无 CRT 组与有 CRT 组的基线特征和手术结果大多相似。无 CRT 组主要结局的发生率更高（43% vs 25%，p=0.041），这归因于死亡率增加（26% vs 11%，p=0.033）。多变量分析后，无 CRT 与主要结局风险增加两倍以上相关（危险比 2.36，95%置信区间 1.1 至 4.98，p=0.017），这一发现仅限于器械有 I 类适应证的患者。两组的次要终点发生率无差异。总之，在接受 TEER 治疗功能性 MR 的 CRT 适应证患者中，在 CRT 之前进行该手术时，1 年临床结局更为有利。
