Gustafson Andrew, Mason O'Neil R, Tilkens Blair, Shrivastav Rishi, Hussain Kifah, Lin Kevin, Puthumana Jyothy J, Narang Akhil
Division of Cardiology, Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA.
Struct Heart. 2024 Oct 26;9(2):100369. doi: 10.1016/j.shj.2024.100369. eCollection 2025 Feb.
An expanded tricuspid regurgitation scale has been shown to be incrementally useful in understanding the response to transcatheter therapies. A similar approach to mitral regurgitation (MR) has not been evaluated. The purpose of this study was to investigate how an expanded MR grading system that includes categories of massive and torrential would regrade patients undergoing transcatheter edge-to-edge repair (TEER) for MR and evaluate procedural outcomes.
We retrospectively identified 142 consecutive patients with severe MR who underwent TEER. Transesophageal echocardiography was used to assess the quantitative severity of MR and reclassify regurgitation into severe, massive, and torrential grades. Similarly, residual MR was assessed postprocedurally.
In the expanded scale, 59% of patients were regraded as severe, 23% as massive, and 18% as torrential, with respective median effective regurgitant orifice area (cm) of 0.45 [0.39, 0.50], 0.68 [0.65, 0.75], and 0.95 [0.85, 1.20]. Ninety-three percent of the entire cohort and 93% of severe, 94% of massive, and 96% of torrential patients, achieved moderate or less MR post-TEER ( = 0.850) with corresponding improvements in New York Heart Association Functional Classification and 12-item Kansas City Cardiomyopathy Questionnaire scores.
An expanded grading system demonstrated that patients with massive and torrential MR still achieve adequate procedural success with reduction in regurgitation and improvement in health status. Further evaluation of how an expanded MR grading scale may be useful is warranted.
已证实一种扩展的三尖瓣反流分级系统在理解经导管治疗的反应方面具有越来越大的作用。二尖瓣反流（MR）的类似方法尚未得到评估。本研究的目的是调查一种包括大量反流和汹涌反流类别的扩展MR分级系统如何对接受经导管缘对缘修复（TEER）治疗MR的患者进行重新分级，并评估手术结果。
我们回顾性地确定了142例连续接受TEER治疗的重度MR患者。经食管超声心动图用于评估MR的定量严重程度，并将反流重新分类为重度、大量反流和汹涌反流等级。同样，术后评估残余MR。
在扩展分级系统中，59%的患者被重新分级为重度，23%为大量反流，18%为汹涌反流，相应的有效反流口面积中位数（cm）分别为0.45 [0.39, 0.50]、0.68 [0.65, 0.75]和0.95 [0.85, 1.20]。整个队列的93%、重度患者的93%、大量反流患者的94%和汹涌反流患者的96%在TEER术后达到中度或更低程度的MR（ = 0.850），纽约心脏协会功能分级和12项堪萨斯城心肌病问卷评分相应改善。
扩展分级系统表明，大量反流和汹涌反流的MR患者在减少反流和改善健康状况方面仍能取得足够的手术成功率。有必要进一步评估扩展MR分级量表可能有何用处。
