一种用于表征经导管缘对缘修复二尖瓣反流的新型血流动力学指标：MPF。
A Novel Hemodynamic Index Characterizing Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair: The MPF.
作者信息
Leone Antonio Maria, Di Giusto Federico, Lucarelli Katya, Vicerè Andrea, Anastasia Gianluca, Galante Domenico, Petrolati Edoardo, Bianchini Francesco, Burzotta Francesco, Aurigemma Cristina, Lombardo Antonella, Locorotondo Gabriella, Graziani Francesca, Casamassima Vito, Grimaldi Massimo, Trani Carlo
机构信息
Unità Operativa Complessa di Cardiologia Diagnostica ed Interventistica - UTIC, Ospedale Isola Tiberina-Gemelli Isola, Roma, Italy.
Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore Roma, Roma, Italy.
出版信息
JACC Adv. 2024 Jul 13;3(8):101099. doi: 10.1016/j.jacadv.2024.101099. eCollection 2024 Aug.
BACKGROUND
Hemodynamic impact of residual mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER) is not always univocally measured by transesophageal echocardiographic (TEE) assessment alone. When analyzing TEER procedure result, operators often encounter discrepancy between TEE guidance and invasive hemodynamic monitoring.
OBJECTIVES
This study sought to investigate the role of invasive hemodynamic monitoring during mitral valve TEER procedure on top of TEE guidance.
METHODS
We analyzed 78 patients with moderate-to-severe or severe MR who underwent TEER. Mitral pulse pressure fraction (MPF) was extracted from intraprocedural continuous left atrial pressure monitoring. Twenty-three patients with the same grade of MR not undergoing TEER were included as a control group. At follow-up, clinical and functional status in the majority of patients undergoing TEER were reassessed by NYHA classification and the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ).
RESULTS
TEER significantly reduced MR burden on both TEE guidance and invasive hemodynamic monitoring. Post-TEER MPF was significantly reduced compared to both pre-TEER setting ( < 0.001) and control group ( < 0.001). At follow-up, while MR reduction assessed by TEE was associated with an improved functional status in terms of the 12-item KCCQ but not of NYHA classification, a greater reduction in MPF was associated with a significant amelioration of both NYHA classification ( = 0.036) and 12-item KCCQ ( = 0.032).
CONCLUSIONS
MPF could provide an immediate estimate of the real hemodynamic impact of MR and a prompt prediction of the functional improvement after TEER.
背景
经导管缘对缘修复术（TEER）后残余二尖瓣反流（MR）的血流动力学影响并非总能仅通过经食管超声心动图（TEE）评估明确测量。在分析TEER手术结果时，术者常常遇到TEE引导与有创血流动力学监测之间的差异。
目的
本研究旨在探讨在TEE引导基础上，有创血流动力学监测在二尖瓣TEER手术中的作用。
方法
我们分析了78例行TEER的中重度或重度MR患者。术中通过连续左心房压力监测提取二尖瓣脉压分数（MPF）。纳入23例相同程度MR但未行TEER的患者作为对照组。随访时，多数接受TEER的患者的临床和功能状态通过纽约心脏协会（NYHA）分级和12项堪萨斯城心肌病问卷（KCCQ）重新评估。
结果
TEE引导和有创血流动力学监测均显示TEER显著降低了MR负担。与TEER术前（<0.001）和对照组（<0.001）相比，TEER术后MPF均显著降低。随访时，虽然TEE评估的MR减少与12项KCCQ评估的功能状态改善相关，但与NYHA分级无关，而MPF更大程度的降低与NYHA分级（=0.036）和12项KCCQ（=0.032）的显著改善相关。
结论
MPF可即时评估MR的实际血流动力学影响，并能迅速预测TEER术后的功能改善情况。
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