Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department IRCCS San Raffaele Scientific Institute Milan Italy.
Echo Lab, Clinica Montevergine, GVM Care and Research Mercogliano Italy.
J Am Heart Assoc. 2024 Jul 16;13(14):e033125. doi: 10.1161/JAHA.123.033125. Epub 2024 Jul 9.
Mitral regurgitation (MR) is frequent in patients with aortic stenosis (AS). Although primary MR is an established negative prognostic factor, whether different mechanisms of MR have different effects on outcome is currently unknown. The aim of this study was to evaluate the impact of the MR mechanism in patients undergoing transcatheter aortic valve replacement (TAVR).
This is a retrospective observational study of patients who underwent TAVR for severe aortic stenosis in a high-volume tertiary care center. Echocardiographic comprehensive MR assessment was performed at baseline and within 3 months post TAVR. The study population was divided into 4 groups according to MR mechanism: Group I: fibro-calcific leaflet degeneration; Group II: prolapse/flail; Group III: ventricular secondary MR (functional MR); and Group IV: atrial functional MR. The study end point was a combination of death from cardiovascular cause and heart failure-related hospitalization. The study population included 427 patients (mean age 81.7±6.5 years; 71% primary MR; 62% ≥moderate MR). At 3-year follow-up, survival free from the composite end point significantly differs according to MR mechanism: it was higher in group IV (atrial functional MR, 96.6%) compared with group I (80.4%, =0.002) and group II patients (60.7%, =0.001), and group III (84.8%, =0.037); patients with MR due to leaflet prolapse showed poorer prognosis compared with patients with functional MR (group III, =0.023 and group IV, =0.001) and with group I (=0.040). Overall, severe MR after TAVR identified patients with poorer prognosis and was significantly more frequent in group II (46.4%, =0.001).
In patients undergoing TAVR, preprocedural identification of MR mechanism and mechanism provides prognostic insights.
主动脉瓣狭窄（AS）患者常并发二尖瓣反流（MR）。虽然原发性 MR 是明确的预后不良因素，但不同机制的 MR 是否对预后有不同影响目前尚不清楚。本研究旨在评估经导管主动脉瓣置换术（TAVR）患者中 MR 机制的影响。
这是一项在高容量三级护理中心接受 TAVR 治疗严重主动脉瓣狭窄的患者的回顾性观察性研究。在基线和 TAVR 后 3 个月进行了超声心动图全面的 MR 评估。根据 MR 机制将研究人群分为 4 组：I 组：纤维-钙化瓣叶退行性变；II 组：脱垂/连枷；III 组：心室继发性 MR（功能性 MR）；IV 组：房性功能性 MR。研究终点是心血管原因死亡和心力衰竭相关住院的复合终点。研究人群包括 427 名患者（平均年龄 81.7±6.5 岁；71%为原发性 MR；62%≥中度 MR）。在 3 年随访时，根据 MR 机制，无复合终点的生存率有显著差异：IV 组（房性功能性 MR，96.6%）明显高于 I 组（80.4%，=0.002）和 II 组（60.7%，=0.001），以及 III 组（84.8%，=0.037）；瓣叶脱垂导致的 MR 患者预后较差，与功能性 MR（III 组，=0.023 和 IV 组，=0.001）和 I 组（=0.040）相比，差异有统计学意义。总体而言，TAVR 后严重 MR 患者的预后较差，且在 II 组更为常见（46.4%，=0.001）。
在接受 TAVR 的患者中，术前确定 MR 机制和机制可提供预后信息。
