经导管缘对缘二尖瓣修复术后二尖瓣瓣口面积小对临床结局的长期影响：一项三维超声心动图研究。
Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study.
机构信息
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
出版信息
J Am Soc Echocardiogr. 2024 Mar;37(3):328-337. doi: 10.1016/j.echo.2023.11.007. Epub 2023 Nov 14.
BACKGROUND
Iatrogenic mitral stenosis is a complication associated with transcatheter edge-to-edge mitral valve repair. Some reports revealed the impact of mean transmitral pressure gradient after procedure on long-term clinical outcomes. However, the association between prognosis and mitral valve orifice area (MVA) after the procedure has been poorly studied. This study aimed to investigate the association between postprocedural small MVA, derived from three-dimensional (3D) transesophageal echocardiography (TEE), and long-term clinical outcomes in 2 cohorts: the degenerative mitral regurgitation (MR) cohort and the functional MR cohort.
METHODS
This retrospective study assessed 279 consecutive patients with 3D TEE data during transcatheter edge-to-edge mitral valve repair between January 2010 and December 2016. Mitral valve orifice area after device implantation was measured by 3D planimetry. The patients with degenerative and functional MR were stratified separately into 2 groups according to postprocedural MVA: normal MVA (MVA > 1.5 cm) group and small MVA (MVA ≤ 1.5 cm) group.
RESULTS
Of the 279 patients, 142 (51%) had degenerative MR and 137 (49%) had functional MR. The number of degenerative MR patients with small MVA was 38, whereas 42 patients were in the functional MR cohort. Patients with small MVA had higher rate of all-cause mortality in the degenerative MR group (log-rank test: P = .01) but not in the functional MR group (log-rank test: P = .52). In multivariate analysis small MVA was independently associated with all-cause mortality but not postprocedural transmitral pressure gradient. Neither small MVA nor transmitral pressure gradient was associated with all-cause mortality in patients with functional MR.
CONCLUSION
Small MVA measured by 3D TEE after transcatheter mitral edge-to-edge repair was associated with poor prognosis in patients with degenerative MR.
背景
医源性二尖瓣狭窄是经导管缘对缘二尖瓣修复术的一种并发症。一些报告揭示了术后平均跨二尖瓣压力梯度对长期临床结果的影响。然而，术后二尖瓣瓣口面积（MVA）与预后之间的关系研究甚少。本研究旨在调查 2 个队列（退行性二尖瓣反流（MR）队列和功能性 MR 队列）中，经导管缘对缘二尖瓣修复术后小 MVA（来自三维（3D）经食管超声心动图（TEE））与长期临床结果之间的关系。
方法
本回顾性研究评估了 2010 年 1 月至 2016 年 12 月期间 279 例连续接受经导管缘对缘二尖瓣修复术的患者的 3D TEE 数据。通过 3D 平面测量技术测量植入装置后的二尖瓣瓣口面积。根据术后 MVA 将退行性和功能性 MR 患者分别分为 2 组：正常 MVA（MVA>1.5cm）组和小 MVA（MVA≤1.5cm）组。
结果
279 例患者中，142 例（51%）患有退行性 MR，137 例（49%）患有功能性 MR。小 MVA 的退行性 MR 患者人数为 38 例，功能性 MR 组则为 42 例。小 MVA 组退行性 MR 患者的全因死亡率较高（log-rank 检验：P=0.01），但功能性 MR 组的全因死亡率无显著差异（log-rank 检验：P=0.52）。多变量分析显示，小 MVA 与全因死亡率独立相关，但与术后跨二尖瓣压力梯度无关。在功能性 MR 患者中，小 MVA 或跨二尖瓣压力梯度与全因死亡率均无关。
结论
经导管二尖瓣缘对缘修复术后 3D TEE 测量的小 MVA 与退行性 MR 患者的不良预后相关。
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