Houston Methodist DeBakey Heart and Vascular Center, TX.
Circ Cardiovasc Interv. 2024 Sep;17(9):e014055. doi: 10.1161/CIRCINTERVENTIONS.124.014055. Epub 2024 Jun 5.
Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment.
We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring. Patients were stratified into 3 groups according to tertiles of post-TEER mean LAP. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models.
We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]).
Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. Exploration of reasons for elevated LAP after M-TEER and ways to lower it warrant further investigation.
左心房压力（LAP）升高与二尖瓣经导管缘对缘修复（M-TEER）后的不良结局相关。我们试图根据最后一个夹子放置后测量的术后 LAP 差异来评估结果。
我们纳入了 2014 年至 2022 年间在我们机构接受 M-TEER 治疗且有 LAP 监测的连续患者。根据术后平均 LAP 的 tertiles 将患者分为 3 组。使用 Kaplan-Meier 分析和 Cox 比例风险模型评估结果。
我们纳入了 273 名患者（平均年龄 76.8±10.8 岁；42.5%为女性；78.4%为白人）。第 1 tertile（n=85）的术后平均 LAP 为 8.7±1.7mm Hg，第 2 tertile（n=95）为 14.4±1.6mm Hg，第 3 tertile（n=93）为 21.9±3.8mm Hg。与第 1 tertile 相比，第 2 和第 3 tertile 在 2 年时全因死亡率或心力衰竭住院的风险均增加（校正后的危险比[adjHR]，2.27 [95%CI，1.25-4.12]和 adjHR，3.00 [95%CI，1.59-5.64]）。在原发性二尖瓣反流患者中，较高的 LAP 与 2 年全因死亡率或心力衰竭住院的风险增加相关（第 2 tertile 与第 1 tertile：adjHR，3.00 [95%CI，1.37-6.56]；第 3 tertile 与第 1 tertile：adjHR，5.52 [95%CI，2.04-14.95]）。然而，在继发性二尖瓣反流患者中，处于第 2 tertile（adjHR，1.53 [95%CI，0.55-4.24]）或第 3 tertile（adjHR，2.18 [95%CI，0.82-5.77]）并不比第 1 tertile 更与复合结局相关。与无 LAP 降低相比，M-TEER 后任何程度的 LAP 降低均与死亡率或心力衰竭住院率降低相关（adjHR，0.59 [95%CI，0.39-0.88]）。
M-TEER 后 LAP 升高与 2 年死亡率或心力衰竭住院风险增加相关。进一步研究 M-TEER 后 LAP 升高的原因以及降低 LAP 的方法是有必要的。
