Güney Murat Can, Süygün Hakan, Polat Melike, Ayhan Hüseyin, Keleş Telat, Turinay Ertop Zeynep Şeyma, Bozkurt Engin
Medicana International Ankara Hospital, Department of Cardiology, Faculty of Medicine, Atılım University, Söğütözü, 2176. Sk. No: 3, Çankaya 06510, Turkey.
Department of Cardiology, Faculty of Medicine, Karamanoglu Mehmetbey University, Karaman Training and Research Hospital, Karaman 70110, Turkey.
Medicina (Kaunas). 2024 Dec 18;60(12):2077. doi: 10.3390/medicina60122077.
: Mitral regurgitation (MR) is a common condition observed in patients undergoing transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis (AS). However, the impact of TAVI on MR outcomes and the factors predicting MR improvement remains uncertain. Understanding these predictors can enhance patient management and guide clinical decisions. : This retrospective cohort study included 156 patients with moderate to severe MR undergoing TAVI. MR severity was assessed via echocardiography at baseline, as well as 6 months and 1 year after TAVI. Patients were divided into groups based on MR reduction: no improvement or worsening, one-degree improvement, and at least two-degree improvement. Clinical, echocardiographic, and procedural characteristics were evaluated as predictive factors for MR improvement after TAVI. : MR reduction occurred in 68% of patients at 6 months and 81% at 1 year. Factors predicting a reduction of two grades or more in MR severity included lower baseline LVEDD (OR = 1.345, 95% CI: 1.112-1.628, = 0.002) lower baseline LA (OR = 1.121, 95% CI: 1.015-1.237, = 0.024), lower baseline LVMI (OR = 1.109, 95% CI: 1.020-1.207, = 0.024), and higher baseline EF levels (OR = 1.701, 95% CI: 1.007-2.871, = 0.047). No significant association was found between MR reduction at 6 months and one-year mortality. ( = 0.65). : Baseline echocardiographic parameters are valuable in predicting MR improvement post-TAVI, with LVMI emerging as a novel predictor. However, MR reduction did not independently predict survival, underscoring the need for further research to optimize patient selection and management strategies in TAVI candidates.
二尖瓣反流（MR）是接受经导管主动脉瓣植入术（TAVI）治疗主动脉瓣狭窄（AS）患者中常见的情况。然而，TAVI对MR结局的影响以及预测MR改善的因素仍不确定。了解这些预测因素可加强患者管理并指导临床决策。
这项回顾性队列研究纳入了156例接受TAVI的中重度MR患者。在基线时以及TAVI后6个月和1年通过超声心动图评估MR严重程度。根据MR减轻情况将患者分为几组：无改善或恶化、一度改善以及至少二度改善。评估临床、超声心动图和手术特征作为TAVI后MR改善的预测因素。
6个月时68%的患者出现MR减轻，1年时为81%。预测MR严重程度降低两级或更多的因素包括较低的基线左心室舒张末期内径（OR = 1.345，95% CI：1.112 - 1.628，P = 0.002）、较低的基线左心房内径（OR = 1.121，95% CI：1.015 - 1.237，P = 0.024）、较低的基线左心室质量指数（OR = 1.109，95% CI：1.020 - 1.207，P = 0.024）以及较高的基线射血分数水平（OR = 1.701，95% CI：1.007 - 2.871，P = 0.047）。6个月时的MR减轻与1年死亡率之间未发现显著关联（P = 0.65）。
基线超声心动图参数在预测TAVI后MR改善方面很有价值，左心室质量指数成为一个新的预测因素。然而，MR减轻并不能独立预测生存，这突出表明需要进一步研究以优化TAVI候选患者的选择和管理策略。
