Kaewkes Danon, Shechter Alon, Patel Vivek, Koren Ofir, Koseki Keita, Chakravarty Tarun, Nakamura Mamoo, Makar Moody, Makkar Raj
Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA.
Queen Sirikit Heart Center of the Northeast, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Catheter Cardiovasc Interv. 2024 Dec;104(7):1479-1490. doi: 10.1002/ccd.31253. Epub 2024 Oct 31.
An enhanced classification of primary mitral regurgitation (PMR) based on extramitral cardiac involvement may refine patient selection and optimize the timing of transcatheter edge-to-edge repair (TEER).
This study aimed to assess the prognostic significance of a recently established classification system that characterizes the extent of extramitral cardiac damage in patients undergoing TEER for PMR.
Consecutive PMR patients who received MitraClip implantation were categorized according to the presence of extramitral cardiac damage, determined through preprocedural echocardiography. The classifications included no damage or only left ventricular dilatation (group 0), left atrial involvement (group 1), right ventricular volume/pressure overload (group 2), right ventricular failure (group 3), or left ventricular failure (group 4). Cox-proportional hazard models were used to ascertain the impact of PMR groups on the primary composite outcome of all-cause mortality or rehospitalization for heart failure (HHF) over 2 years.
In a cohort of 322 eligible PMR patients undergoing TEER (median age: 83 years; 41% female) between 2013 and 2020, the following distribution emerged: group 0 (10 patients, 3%), group 1 (96 patients, 30%), group 2 (117 patients, 36%), group 3 (56 patients, 18%), and group 4 (43 patients, 13%). Kaplan-Meier analysis demonstrated a significant decline in freedom from the primary outcome as group severity increased (log-rank p = 0.030). On multivariate analysis, the degree of extramitral cardiac involvement was significantly associated with the primary outcome (HR: 1.30; 95% CI: 1.02-1.67; p = 0.043), primarily driven by HHF.
This innovative classification system for PMR, based on extramitral cardiac involvement, carries significant prognostic implications for clinical outcomes following TEER. Integrating this classification system into clinical decision-making could enhance risk stratification and optimize the timing of TEER in these patients.
基于瓣外心脏受累情况对原发性二尖瓣反流（PMR）进行强化分类，可能会优化患者选择，并为经导管缘对缘修复术（TEER）确定最佳时机。
本研究旨在评估一种最近建立的分类系统的预后意义，该系统用于描述接受TEER治疗的PMR患者的瓣外心脏损伤程度。
连续纳入接受MitraClip植入术的PMR患者，根据术前超声心动图确定的瓣外心脏损伤情况进行分类。分类包括无损伤或仅有左心室扩张（0组）、左心房受累（1组）、右心室容量/压力超负荷（2组）、右心室衰竭（3组）或左心室衰竭（4组）。采用Cox比例风险模型确定PMR各亚组对2年内全因死亡率或心力衰竭再住院（HHF）这一主要复合结局的影响。
在2013年至2020年间接受TEER的322例符合条件的PMR患者队列中（中位年龄：83岁；41%为女性），出现了以下分布情况：0组（10例患者，3%）、1组（96例患者，30%）、2组（117例患者，36%）、3组（56例患者，18%）和4组（43例患者，13%）。Kaplan-Meier分析表明，随着组严重程度增加，主要结局的无事件生存率显著下降（对数秩检验p = 0.030）。多因素分析显示，瓣外心脏受累程度与主要结局显著相关（风险比：1.30；95%置信区间：1.02 - 1.67；p = 0.043），主要由HHF驱动。
这种基于瓣外心脏受累情况的PMR创新分类系统，对TEER后的临床结局具有重要的预后意义。将该分类系统纳入临床决策可增强风险分层，并优化这些患者的TEER时机。
