Hashimoto Sho, Yamano Michiyo, Yamano Tetsuhiro, Zen Kan, Matsubara Yuki, Takamatsu Kazuaki, Yashige Masaki, Nakamura Takeshi, Shiraishi Hirokazu, Matoba Satoaki
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Echocardiography. 2023 Dec;40(12):1374-1382. doi: 10.1111/echo.15716. Epub 2023 Nov 20.
Residual regurgitation after transcatheter edge-to-edge mitral valve repair (TMVR) is a predictor of poor prognosis in patients with functional mitral regurgitation (FMR). This study sought to identify the mitral valve (MV) parameters measured by three-dimensional transesophageal echocardiography (3D-TEE) and MV leaflet features that predict residual mitral regurgitation (MR) after TMVR in patients with FMR.
Consecutive patients with FMR who underwent TMVR were classified into two groups based on the degree of residual MR just after TMVR: < 2+ in the optimal MR reduction group and ≥ 2+ in the suboptimal MR reduction group. The two groups were compared with respect to 3D-TEE parameters and the MV leaflet features, including the following parameters: stiffness, defined as a leaflet that remains at a fixed angle even during diastole, and thickness, measured in both clear and rough zones.
Thirty-four of 46 patients (74%) were classified as the optimal MR reduction group. Multivariable analysis showed that anterior mitral leaflet + posterior mitral leaflet length/anteroposterior annulus diameter (p = .044) and MV leaflet stiffness (p = .007) were independent predictors of residual MR.
MV leaflet stiffness and the ratio of MV leaflet lengths to the annulus diameter may be good predictors of residual MR after TMVR in patients with FMR.
经导管二尖瓣缘对缘修复术（TMVR）后残留反流是功能性二尖瓣反流（FMR）患者预后不良的预测指标。本研究旨在确定通过三维经食管超声心动图（3D-TEE）测量的二尖瓣（MV）参数以及MV瓣叶特征，这些参数和特征可预测FMR患者TMVR术后的残留二尖瓣反流（MR）。
连续接受TMVR的FMR患者根据TMVR术后即刻的残留MR程度分为两组：最佳MR降低组<2+，次优MR降低组≥2+。比较两组的3D-TEE参数和MV瓣叶特征，包括以下参数：僵硬程度，定义为即使在舒张期也保持固定角度的瓣叶，以及在清晰区和粗糙区测量的厚度。
46例患者中有34例（74%）被分类为最佳MR降低组。多变量分析显示，二尖瓣前叶+二尖瓣后叶长度/前后瓣环直径（p = .044）和MV瓣叶僵硬程度（p = .007）是残留MR的独立预测指标。
MV瓣叶僵硬程度以及MV瓣叶长度与瓣环直径的比值可能是FMR患者TMVR术后残留MR的良好预测指标。
