右心室-肺动脉耦联对接受经导管二尖瓣缘对缘修复术患者的重塑及预后的影响
Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair.
作者信息
Koschutnik Matthias, Donà Carolina, Nitsche Christian, Kammerlander Andreas A, Dannenberg Varius, Brunner Christina, Koschatko Sophia, Mascherbauer Katharina, Heitzinger Gregor, Halavina Kseniya, Spinka Georg, Winter Max-Paul, Hülsmann Martin, Bartko Philipp E, Hengstenberg Christian, Mascherbauer Julia, Goliasch Georg
机构信息
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria.
出版信息
Clin Res Cardiol. 2025 Feb;114(2):156-167. doi: 10.1007/s00392-023-02318-w. Epub 2023 Oct 23.
BACKGROUND
Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.
METHODS
Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.
RESULTS
Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54%, p < 0.001).
CONCLUSIONS
TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.
背景
右心室-肺动脉（RV-PA）耦合最近被证明与瓣膜性心脏病的预后相关。然而，关于经导管二尖瓣缘对缘修复术（M-TEER）后患者右心室功能障碍和心脏逆向重构的纵向数据很少。
方法
前瞻性纳入连续性原发性及继发性二尖瓣反流（MR）患者，并在基线时进行全面的超声心动图和有创血流动力学评估。采用心力衰竭住院和死亡的复合终点进行Kaplan-Meier估计和多变量Cox回归分析。
结果
2018年4月至2021年1月期间，156例患者（中位年龄78岁，55%为女性，欧洲心脏手术风险评估系统II：6.9%）接受了M-TEER。就诊时，64%的患者表现为RV-PA耦合受损，定义为三尖瓣环平面收缩期位移与肺动脉收缩压（TAPSE/PASP）之比<0.36。耦合受损患者的2年无事件生存率显著较低（57%对82%，p<0.001），原发性MR患者（64%对91%，p=0.009）和继发性MR患者（54%对76%，p=0.026）均如此。在对基线、影像学、血流动力学和手术数据进行调整的多变量Cox回归分析中，TAPSE/PASP比值<0.36与预后独立相关（调整后HR 2.74，95%CI 1.17-6.43，p=0.021）。在1年随访时，RV-PA耦合得到改善（TAPSE：增加3mm，PASP：降低10mmHg，两者p均<0.001），同时三尖瓣反流（TR）严重程度降低（≥II级：77%-54%，p<0.001）。
结论
TAPSE/PASP比值与接受M-TEER治疗的原发性和继发性MR患者的预后相关。M-TEER后RV-PA耦合以及TR严重程度均得到改善，因此除了已有的不良预后标志物外，还可能提供预后信息。
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