心力衰竭严重程度对二尖瓣经导管缘对缘瓣膜修复术死亡率获益的影响。
Impact of heart failure severity on the mortality benefit of mitral transcatheter edge-to-edge valve repair.
作者信息
Magni Valeria, Adamo Marianna, Pezzola Elisa, Rubbio Antonio Popolo, Giannini Cristina, Masiero Giulia, Grasso Carmelo, Denti Paolo, Giordano Arturo, De Marco Federico, Bartorelli Antonio L, Montorfano Matteo, Godino Cosmo, Baldi Cesare, De Felice Francesco, Mongiardo Annalisa, Monteforte Ida, Villa Emmanuel, Crimi Gabriele, Tusa Maurizio, Testa Luca, Serafini Lisa, Cani Dario, Guarini Giacinta, Huqi Alda, Sesana Marco, De Carlo Marco, Maisano Francesco, Tarantini Giuseppe, Tamburino Corrado, Bedogni Francesco, Metra Marco
机构信息
Division of Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Division of Cardiology, Ospedale di Desenzano, Desenzano, Italy.
出版信息
Clin Res Cardiol. 2024 Jul 24. doi: 10.1007/s00392-024-02490-7.
BACKGROUND
To assess the interaction between heart failure (HF) severity and optimal reduction of secondary mitral regurgitation (SMR) on mortality in patients undergoing transcatheter edge-to-edge repair (M-TEER).
METHODS AND RESULTS
Among 1656 patients included in the Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) 984 had SMR and complete data on advanced HF. Advanced HF was defined as NYHA class III or IV, left ventricular ejection fraction ≤ 30%, and > 1 HF hospitalization during the last 12 months. Optimal M-TEER was defined as residual SMR ≤ 1 + at discharge. One hundred sixteen patients (11.8%) had advanced HF. Achievement of an optimal SMR reduction was similar in patients with and without advanced HF (65% and 60% respectively). Advanced HF was an independent predictor of 2-year all-cause death (adjusted HR 1.52, 95% CI 1.09-2.10). Optimal M-TEER, as compared to a no-optimal M-TEER, was associated with a reduced risk of death both in patients with advanced (HR 0.55, 95% CI 0.32-0.97; p = 0.039) and no-advanced HF (HR 0.59, 95% CI 0.46-0.78; p < 0.001; p = 0.778 for interaction).
CONCLUSIONS
Advanced HF is associated with poor outcome in patients undergoing M-TEER. However, an optimal SMR reduction reduces the risk of 2-year mortality regardless of HF severity.
背景
评估心力衰竭（HF）严重程度与经导管缘对缘修复术（M-TEER）患者继发性二尖瓣反流（SMR）最佳减少程度之间的相互作用对死亡率的影响。
方法与结果
在意大利介入心脏病学会（GIse）二尖瓣反流经导管治疗注册研究（GIOTTO）纳入的1656例患者中，984例有SMR且有晚期HF的完整数据。晚期HF定义为纽约心脏协会（NYHA）心功能III或IV级、左心室射血分数≤30%且在过去12个月内有>1次HF住院。最佳M-TEER定义为出院时残余SMR≤1+。116例患者（11.8%）有晚期HF。有和没有晚期HF的患者实现最佳SMR减少的情况相似（分别为65%和60%）。晚期HF是2年全因死亡的独立预测因素（校正后风险比1.52，95%置信区间1.09-2.10）。与非最佳M-TEER相比，最佳M-TEER与晚期HF患者（风险比0.55，95%置信区间0.32-0.97；p=0.039）和非晚期HF患者（风险比0.59，95%置信区间0.46-0.78；p<0.001；交互作用p=0.778）的死亡风险降低相关。
结论
晚期HF与接受M-TEER的患者预后不良相关。然而，无论HF严重程度如何，最佳SMR减少可降低2年死亡率风险。
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