Division of Cardiology, Ospedale di Cremona, Cremona, Italy.
Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy.
Int J Cardiol. 2024 Oct 15;413:132317. doi: 10.1016/j.ijcard.2024.132317. Epub 2024 Jul 8.
The aims of this study were: i) to report the prevalence of low-risk patients with degenerative mitral regurgitation (DMR) undergoing mitral transcatheter edge-to-edge repair (M-TEER) in a real-world setting; ii) to evaluate the prognostic significance of EuroSCORE II; iii) to determine whether an optimal M-TEER provides a mortality benefit regardless of EuroSCORE-II.
We analyzed data from the GIOTTO registry that enrolled patients undergoing M-TEER in Italy. We included only patients with DMR. Two groups were defined: patients with EuroSCORE<4% and with EuroSCORE≥4%. A further stratification according to variables included in the EuroSCORE-II was made. Interaction between EuroSCORE-II and optimal procedural success was evaluated. Outcome of interest was all-cause death at 2-year.
Among 1659 patients prospectively enrolled in the GIOTTO registry, 657 had DMR, 364 with an EuroSCORE<4% (53%) and 311 with an EuroSCORE≥4% (47%). Patients with lower EuroSCORE were older with less comorbidities. All-cause mortality was higher in patients with EuroSCORE≥ vs <4%. EuroSCORE II ≥ 4% was independently associated with an increased risk of mortality (HR 2.36, 95%CI 1.28-4.38, p = 0.007). Among variables included in the EuroSCORE-II, Left Ventricular Ejection Fraction<35% and systolic Pulmonary Artery Pressure ≥ 50mmhg were independent predictors of clinical outcome. Two-year all-cause death was higher in patients without optimal MR reduction regardless of the calculated surgical risk (p for interaction 0.3).
More than half of patients with DMR undergoing M-TEER had a Euroscore<4% with a median age of 81. An optimally successful M-TEER was associated with a lower mortality regardless of EuroSCORE.
本研究旨在：i）报告在真实环境中接受经导管二尖瓣缘对缘修复术（M-TEER）的退行性二尖瓣反流（DMR）低危患者的患病率；ii）评估 EuroSCORE II 的预后意义；iii）确定无论 EuroSCORE-II 如何，优化的 M-TEER 是否能带来死亡率的降低。
我们分析了在意大利进行 M-TEER 的 GIOTTO 注册研究的数据。我们仅纳入 DMR 患者。定义了两组：EuroSCORE<4%和 EuroSCORE≥4%。根据 EuroSCORE-II 中包含的变量进行了进一步分层。评估了 EuroSCORE-II 和最佳手术成功率之间的相互作用。观察终点为 2 年全因死亡率。
在 GIOTTO 注册研究中，前瞻性纳入了 1659 例患者，其中 657 例患有 DMR，364 例 EuroSCORE<4%（53%），311 例 EuroSCORE≥4%（47%）。EuroSCORE 较低的患者年龄较大，合并症较少。EuroSCORE≥4%的患者全因死亡率较高。EuroSCORE II≥4%与死亡率增加独立相关（HR 2.36，95%CI 1.28-4.38，p=0.007）。在 EuroSCORE-II 中包含的变量中，左心室射血分数<35%和收缩期肺动脉压≥50mmHg 是临床结局的独立预测因素。无论计算的手术风险如何，未达到最佳二尖瓣反流减轻的患者 2 年全因死亡率均较高（交互作用的 p 值为 0.3）。
接受 M-TEER 的 DMR 患者中，超过一半的患者 Euroscore<4%，中位年龄为 81 岁。无论 EuroSCORE 如何，优化的 M-TEER 与死亡率降低相关。
