Tadic Marijana, Schneider Leonhard, Nita Nicoleta, Felbel Dominik, Paukovitsch Michael, Gröger Mathias, Keßler Mirjam, Rottbauer Wolfang
Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany.
Clin Cardiol. 2024 Dec;47(12):e70062. doi: 10.1002/clc.70062.
The aim of this study was to investigate the influence of systolic blood pressure (SBP) values on admission on the outcome of mitral transcatheter edge-to-edge repair (M-TEER).
We included all patients who underwent interventional MV repair in our institution between January 2010 and October 2020. All data are obtained from the MiTra ULM registry. Based on SBP values measured on admission, all patients were divided into four groups: < 120, 120-129, 130-139, and ≥ 140 mmHg.
Eight hundred and fifty-eight patients were included in this study. There were no major differences in demographic and clinical characteristics between the four observed groups. The patients with SBP on admission ≥ 140 mmHg had the lowest prevalence of functional MR and the highest LVEF. Higher SBP at admission (HR 0.74, 95% CI: 0.63-0.87) and preprocedural LVEF values (HR 0.99, 95% CI: 0.97-0.99) were predictors of lower 1-year mortality but did not impact 1-year hospitalization rate or MACE in the whole study population. When patients were separated into two groups according to the mechanisms of MR (functional and structural), the results showed that higher SBP on admission and better preprocedural LVEF were associated with significantly lower 1-year CV mortality in both groups of patients, with functional and structural MR. Higher SBP at admission was also associated with lower 1-year CV mortality (HR 0.73, 95% CI: 0.55-0.96) in patients with preserved ejection fraction (LVEF > 50%), but not with 1-year rehospitalization and MACE.
Higher SBP on admission (> 140 mmHg) is an independent predictor of a better 1-year outcome in patients treated with M-TEER. The effect of higher SBP on outcome after M-TEER should be further investigated.
本研究旨在探讨入院时收缩压（SBP）值对经导管二尖瓣缘对缘修复术（M-TEER）结果的影响。
我们纳入了2010年1月至2020年10月在我院接受介入性二尖瓣修复的所有患者。所有数据均来自MiTra ULM登记处。根据入院时测得的SBP值，将所有患者分为四组：<120、120-129、130-139和≥140 mmHg。
本研究共纳入858例患者。四个观察组在人口统计学和临床特征方面无重大差异。入院时SBP≥140 mmHg的患者功能性二尖瓣反流患病率最低，左心室射血分数（LVEF）最高。入院时较高SBP（风险比[HR]0.74，95%置信区间[CI]：0.63-0.87）和术前LVEF值（HR 0.99，95%CI：0.97-0.99）是1年死亡率较低的预测因素，但对整个研究人群的1年住院率或主要不良心血管事件（MACE）无影响。当根据二尖瓣反流机制（功能性和结构性）将患者分为两组时，结果显示，入院时较高SBP和较好术前LVEF与功能性和结构性二尖瓣反流两组患者的1年心血管死亡率显著降低相关。入院时较高SBP也与射血分数保留（LVEF>50%）患者的1年心血管死亡率较低（HR 0.73，95%CI：0.55-0.96）相关，但与1年再住院率和MACE无关。
入院时较高SBP（>140 mmHg）是接受M-TEER治疗患者1年预后较好的独立预测因素。较高SBP对M-TEER术后结果的影响应进一步研究。
