Cardiology Department, University Clinic Hospital, Valladolid, Spain.
Cardiology Department, University Hospital of León, León, Spain.
Catheter Cardiovasc Interv. 2024 Aug;104(2):378-389. doi: 10.1002/ccd.31115. Epub 2024 Jun 3.
Vasopressor test (VPT) might be useful in patients with functional mitral regurgitation (MR) and left ventricular dysfunction (MITRA-FR-like patients) during transcatheter edge-to-edge repair (TEER).
We aimed to evaluate the prognostic impact of VPT.
MR treated with TEER were included in a multicenter prospective registry. VPT was used intraprocedurally in patients with left ventricular dysfunction and/or hypotension. The 1-year echocardiographic and clinical outcomes were compared according to the use of VPT. The primary endpoint was a combination of mortality + heart failure (HF) readmission at 1-year.
A total of 1115 patients were included, mean age was 72.8 ± 10.5 years and 30.4% were women. VPT was performed in 128 subjects (11.5%), more often in critically ill patients with biventricular dysfunction. Postprocedurally the VPT group had greater rate of MR ≥ 2+ (46.9% vs. 31.7%, p = 0.003) despite greater number of devices (≥2 clips, 52% vs. 40.6 p = 0.008) and device repositioning or new clip in 12.5%. At 1-year, the primary endpoint occurred more often in the VPT group (27.3% vs. 16.9%, p = 0.002) as well as all-cause mortality (21.9% vs. 8.1%, p ≤ 0.001) but no differences existed in HF readmission rate (14.8% vs. 13.2%, p = 0.610), cardiovascular mortality (4.4% vs. 3.9%, p = 0.713) or residual MR ≥ 2+ (51.1% vs 51.7%, p = 0.371).
Dynamic evaluation of MR during TEER procedure through VPT was performed in patients with worse baseline risk who also presented higher all-cause mortality at 1-year follow-up. However, 1-year residual MR, cardiovascular mortality and HF readmission rate remained comparable suggesting that VPT might help in the management of MITRA-FR-like patients.
在经导管缘对缘修复（TEER）过程中，血管加压素试验（VPT）可能对功能性二尖瓣反流（MR）伴左心室功能障碍（MITRA-FR 样患者）有用。
我们旨在评估 VPT 的预后影响。
我们纳入了一项多中心前瞻性登记研究中接受 TEER 治疗的 MR 患者。在左心室功能障碍和/或低血压的患者中，术中使用 VPT。根据 VPT 的使用情况比较 1 年的超声心动图和临床结局。主要终点是 1 年时死亡率+心力衰竭（HF）再入院的联合终点。
共纳入 1115 例患者，平均年龄为 72.8±10.5 岁，30.4%为女性。128 例（11.5%）患者进行了 VPT，这些患者多为有双心室功能障碍的危重症患者。尽管植入了更多的器械（≥2 个夹子，52% vs. 40.6%，p=0.008），并在 12.5%的患者中重新定位或新增夹子，但术后 VPT 组的 MR≥2+发生率更高（46.9% vs. 31.7%，p=0.003）。1 年时，VPT 组的主要终点发生率更高（27.3% vs. 16.9%，p=0.002），全因死亡率（21.9% vs. 8.1%，p≤0.001）也更高，但 HF 再入院率（14.8% vs. 13.2%，p=0.610）、心血管死亡率（4.4% vs. 3.9%，p=0.713）或残余 MR≥2+（51.1% vs. 51.7%，p=0.371）无差异。
在 TEER 过程中通过 VPT 对 MR 进行动态评估，用于基线风险较差的患者，这些患者在 1 年随访时的全因死亡率更高。然而，1 年时残余 MR、心血管死亡率和 HF 再入院率仍相当，表明 VPT 可能有助于 MITRA-FR 样患者的管理。
