Yamano Michiyo, Yamano Tetsuhiro, Nakamura Takeshi, Zukeran Tomoka, Matsubara Yuki, Yagi Nobuichirou, Takigami Masao, Nakanishi Naohiko, Zen Kan, Shiraishi Hirokazu, Matoba Satoaki
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Int J Cardiol. 2024 Jan 15;395:131404. doi: 10.1016/j.ijcard.2023.131404. Epub 2023 Sep 29.
Worsening mitral regurgitation (MR) is a complication of intervention for atrial septal defect (ASD). Little is known about mitral valve (MV) characteristics associated with worsening MR. We aimed to elucidate MR outcomes and predictors of worsening MR after transcatheter ASD closure.
We analyzed changes in MR from prior to transcatheter ASD closure to 6 months after the procedure and predictors of worsening MR via baseline transthoracic echocardiography in 238 patients (64.7% females; mean age, 53 ± 22 years).
Worsening MR was defined as worsening to moderate in patients with less than or equal to mild MR at baseline or vena contracta width increasing of ≥2 mm by 6-month follow-up in patients with moderate MR. Worsening MR was observed in 29 patients (12.2%). The associated echocardiographic findings were pseudoprolapse, hamstringing, stiffness, and anteroposterior and intercommissural mitral annulus diameter in the univariable logistic regression analysis (all P < 0.05). Multivariable analysis after adjusting for age; long-standing persistent atrial fibrillation; and ASD size showed that models combining MV leaflet findings such as pseudoprolapse or hamstringing, or anterior leaflet stiffness with the ratio of the sum of anterior and posterior leaflet lengths to intercommissural mitral annulus diameter were statistically significant for predicting worsening MR (R = 0.393, P < 0.001 and R = 0.385, P < 0.001, respectively).
Worsening MR after transcatheter ASD closure might depend on MV leaflet findings and annulus size in patients with long-standing persistent atrial fibrillation.
二尖瓣反流（MR）恶化是房间隔缺损（ASD）介入治疗的一种并发症。关于与MR恶化相关的二尖瓣（MV）特征知之甚少。我们旨在阐明经导管ASD封堵术后MR的结果及MR恶化的预测因素。
我们分析了238例患者（64.7%为女性；平均年龄53±22岁）经导管ASD封堵术前至术后6个月MR的变化，以及通过基线经胸超声心动图预测MR恶化的因素。
MR恶化定义为基线时轻度或以下的MR患者恶化至中度，或中度MR患者在6个月随访时反流束缩流宽度增加≥2mm。29例患者（12.2%）出现MR恶化。单因素逻辑回归分析中，相关的超声心动图表现为假性脱垂、受限、僵硬以及二尖瓣前后环和瓣环间径（所有P<0.05）。在对年龄、长期持续性房颤和ASD大小进行校正后的多因素分析显示，将MV瓣叶表现如假性脱垂或受限，或前叶僵硬与前后叶长度之和与二尖瓣瓣环间径的比值相结合的模型对预测MR恶化具有统计学意义（R=0.393，P<0.001和R=0.385，P<0.001）。
对于长期持续性房颤患者，经导管ASD封堵术后MR恶化可能取决于MV瓣叶表现和瓣环大小。
