Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
EuroIntervention. 2024 Nov 18;20(22):1430-1441. doi: 10.4244/EIJ-D-23-01092.
Little is known about the effects of left ventricular ejection fraction (LVEF) worsening after transcatheter edge-to-edge valve repair (TEER) for mitral regurgitation (MR).
This study investigated the predictors and clinical impact of LVEF worsening after TEER for primary MR (PMR) and secondary MR (SMR).
This study included 2,019 patients (493 with PMR and 1,526 with SMR) undergoing successful TEER (postprocedural MR grade ≤2+) in the OCEAN-Mitral registry. The patients were categorised into worsened LVEF (wEF), defined as a relative decrease of >12.9% in LVEF at discharge, and preserved LVEF (pEF). The serial changes in left ventricular (LV) function at 1 year were also evaluated.
Following TEER, 657 (32%) patients demonstrated wEF. The pEF group demonstrated both decreased left ventricular end-diastolic volumes (LVEDV) and end-systolic volumes (LVESV), and the wEF group showed significantly increased LVESV at discharge. Higher LVEF, larger LVEDV, higher B-type natriuretic peptide levels, and moderate/severe aortic regurgitation predicted wEF. Compared with baseline, the wEF group still demonstrated lower LVEF (46% to 43%; p<0.001) but significantly increased stroke volume (48 mL to 53 mL; p=0.001) at 1 year. The incidence of death or heart failure hospitalisation was similar between the wEF and pEF groups (hazard ratio 1.14, 95% confidence interval: 0.72-1.80; p=0.84) and also in patients with PMR and SMR.
LVEF worsening after TEER was not uncommon and was caused by the increased LVESV. LV volumes and some patient-specific factors predicted worsened LVEF which was not associated with long-term clinical outcomes. OCEAN-Mitral registry: UMIN-CTR ID: UMIN000023653.
对于经导管缘对缘修复（TEER）治疗二尖瓣反流（MR）后左心室射血分数（LVEF）恶化的影响知之甚少。
本研究旨在探讨原发性 MR（PMR）和继发性 MR（SMR）经 TEER 治疗后 LVEF 恶化的预测因素和临床影响。
本研究纳入了 2019 例在 OCEAN-Mitral 注册研究中成功接受 TEER（术后 MR 分级≤2+）的患者（493 例为 PMR，1526 例为 SMR）。患者分为 LVEF 恶化组（wEF）和保留 LVEF 组（pEF），wEF 定义为 LVEF 在出院时相对下降>12.9%。还评估了 1 年时左心室（LV）功能的变化。
TEER 后，657 例（32%）患者出现 wEF。pEF 组表现为 LV 舒张末期容积（LVEDV）和收缩末期容积（LVESV）均降低，而 wEF 组在出院时 LVESV 显著增加。较高的 LVEF、较大的 LVEDV、较高的 B 型利钠肽水平和中重度主动脉瓣反流预测了 wEF。与基线相比，wEF 组在 1 年时仍表现出较低的 LVEF（46%降至 43%；p<0.001），但 LV 每搏量显著增加（48 毫升至 53 毫升；p=0.001）。wEF 组和 pEF 组的死亡率或心力衰竭住院率相似（风险比 1.14，95%置信区间：0.72-1.80；p=0.84），PMR 和 SMR 患者也是如此。
TEER 后 LVEF 恶化并不少见，是由 LVESV 增加引起的。LV 容积和一些患者特定因素预测了 LVEF 的恶化，但与长期临床结局无关。OCEAN-Mitral 注册研究：UMIN-CTR ID：UMIN000023653。
