Yin Minyan, Lu Yuntao, Yang Xue, Dong Lili, Wang Xiaolin, Wei Lai
Shanghai Institute of Medical Imaging, 200032 Shanghai, China.
Department of Radiology, Zhongshan Hospital, Fudan University, 200032 Shanghai, China.
Rev Cardiovasc Med. 2024 Jul 2;25(7):241. doi: 10.31083/j.rcm2507241. eCollection 2024 Jul.
The improvement rate and predictors of secondary mitral regurgitation in patients with aortic regurgitation undergoing transcatheter aortic valve replacement (TAVR) remain unclear. This study aimed to identify predictors of persistent moderate to severe secondary mitral regurgitation after TAVR in patients with aortic regurgitation by assessing mitral valve geometry with computed tomography (CT).
This retrospective cohort study reviewed 242 consecutive patients with aortic regurgitation who underwent TAVR between May 2014 and December 2022. Patients with primary or less than moderate mitral regurgitation were excluded. Mitral annular dimensions (area, perimeter, anteroposterior, intercommissural, and trigone-to-trigone diameter), mitral valve tenting geometry (mitral valve tenting area [MVTA] and mitral valve tenting height [MVTH]), and papillary muscle displacement were systematically measured at CT. Mitral regurgitation improvement was assessed at 3 months after TAVR by echocardiography. Logistic regression was performed to explore the association of mitral valve geometry with mitral regurgitation improvement after TAVR.
A total of 75 patients (mean age, 74 7 years; 32.0% female) with moderate to severe secondary mitral regurgitation were included in the final analysis. Mitral regurgitation improved in 49 patients and remained unchanged in 26 patients. Mitral annular dimensions, including area, perimeter, anteroposterior, and intercommissural diameter, were associated with mitral regurgitation improvement. MVTA and MVTH were risk factors for sustained mitral regurgitation. In addition, QRS duration 120 ms and atrial fibrillation had an impact on the mitral regurgitation improvement. Mitral annular area (odds ratio [OR], 1.41; 95% confidence interval [CI]: 1.05, 1.90; = 0.02) and MVTA (OR, 7.24; 95% CI: 1.72, 30.44; = 0.007) were independent predictors of persistent secondary mitral regurgitation after TAVR.
Mitral annular area and MVTA were independent predictors of persistent secondary mitral regurgitation after TAVR.
经导管主动脉瓣置换术（TAVR）治疗主动脉瓣关闭不全患者时，继发性二尖瓣反流的改善率及预测因素尚不清楚。本研究旨在通过计算机断层扫描（CT）评估二尖瓣几何形态，确定主动脉瓣关闭不全患者TAVR术后持续性中重度继发性二尖瓣反流的预测因素。
这项回顾性队列研究纳入了2014年5月至2022年12月期间连续接受TAVR治疗的242例主动脉瓣关闭不全患者。排除原发性或轻度二尖瓣反流患者。在CT上系统测量二尖瓣环尺寸（面积、周长、前后径、瓣环间径和三角到三角直径）、二尖瓣帐篷样几何形态（二尖瓣帐篷样面积[MVTA]和二尖瓣帐篷样高度[MVTH]）以及乳头肌移位。在TAVR术后3个月通过超声心动图评估二尖瓣反流的改善情况。进行逻辑回归分析以探讨二尖瓣几何形态与TAVR术后二尖瓣反流改善之间的关联。
最终分析纳入了75例中重度继发性二尖瓣反流患者（平均年龄74±7岁；女性占32.0%）。49例患者二尖瓣反流得到改善，26例患者无变化。二尖瓣环尺寸，包括面积、周长、前后径和瓣环间径，与二尖瓣反流改善相关。MVTA和MVTH是持续性二尖瓣反流的危险因素。此外，QRS波时限≥120 ms和心房颤动对二尖瓣反流改善有影响。二尖瓣环面积（比值比[OR]，1.41；95%置信区间[CI]：1.05，1.90；P = 0.02）和MVTA（OR，7.24；95%CI：1.72，30.44；P = 0.007）是TAVR术后持续性继发性二尖瓣反流的独立预测因素。
二尖瓣环面积和MVTA是TAVR术后持续性继发性二尖瓣反流的独立预测因素。
