经导管缘对缘修复术对心脏结节病患者的影响：来自OCEAN二尖瓣注册研究的见解
Impact of Transcatheter Edge-to-Edge Repair in Patients With Cardiac Sarcoidosis: Insights From the OCEAN-Mitral Registry.
作者信息
Hiruma Takashi, Saji Mike, Nanasato Mamoru, Takamisawa Itaru, Higuchi Ryosuke, Izumi Yuki, Abe Ryo, Isobe Mitsuaki, Yamamoto Masanori, Kubo Shunsuke, Asami Masahiko, Enta Yusuke, Shirai Shinichi, Izumo Masaki, Mizuno Shingo, Watanabe Yusuke, Amaki Makoto, Kodama Kazuhisa, Yamaguchi Junichi, Naganuma Toru, Bota Hiroki, Ohno Yohei, Hachinohe Daisuke, Yamawaki Masahiro, Ueno Hiroshi, Mizutani Kazuki, Otsuka Toshiaki, Hayashida Kentaro
机构信息
Department of Cardiology Sakakibara Heart Institute Tokyo Japan.
Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan.
出版信息
J Am Heart Assoc. 2025 Apr;14(7):e039243. doi: 10.1161/JAHA.124.039243. Epub 2025 Mar 27.
BACKGROUND
In patients with sarcoidosis, cardiac involvement is a crucial prognostic factor leading to severe cardiovascular events. Mitral regurgitation (MR) predisposes patients to drug-refractory heart failure; however, MR in patients with cardiac sarcoidosis (CS) has been scarcely investigated and its therapeutic approach remains unclear. This study aimed to investigate the clinical impact of transcatheter edge-to-edge repair in patients with CS.
METHODS
Patients with CS-related ventricular functional MR were compared with those with other nonischemic cardiomyopathies in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry in Japan.
RESULTS
Among 1240 patients with nonischemic cardiomyopathy-related ventricular functional MR, 40 (3.2%) had CS. Of these, 18 patients (45.0%) had immunosuppressive therapy. Twenty-seven patients (67.5%) were New York Heart Association function class III/IV. Patients with CS were more likely to be younger and female, had a higher prevalence of ventricular tachyarrhythmia and cardiac resynchronization therapy, and had a larger left ventricle with more severe MR than the others. At the procedure, 38 patients (95.0%) had devices placed at the central lesion. All patients with CS were successfully treated, leading to immediate improvement of cardiac output. At 1-year follow-up, 89.3% had MR ≤2+ and 40.0% had New York Heart Association function class I. Despite similar outcomes between groups, greater remnant MR and fatal arrhythmic events in those with CS may be due to inadequate reverse remodeling and ongoing left ventricle damage caused by inflammation.
CONCLUSIONS
Transcatheter edge-to-edge repair is an effective heart failure treatment for patients with CS-related MR; however, the drug- and cardiac device-refractory cardiomyopathy in this population warrants careful management.
REGISTRATION
URL: www.umin.ac.jp/english/; Unique Identifier: UMIN000023653.
背景
在结节病患者中，心脏受累是导致严重心血管事件的关键预后因素。二尖瓣反流（MR）使患者易患药物难治性心力衰竭；然而，心脏结节病（CS）患者的MR鲜有研究，其治疗方法仍不明确。本研究旨在探讨经导管缘对缘修复对CS患者的临床影响。
方法
在日本的OCEAN（优化导管瓣膜干预）-二尖瓣登记研究中，将CS相关心室功能MR患者与其他非缺血性心肌病患者进行比较。
结果
在1240例非缺血性心肌病相关心室功能MR患者中，40例（3.2%）患有CS。其中，18例（45.0%）接受了免疫抑制治疗。27例（67.5%）为纽约心脏协会心功能Ⅲ/Ⅳ级。CS患者更可能年轻且为女性，室性快速心律失常和心脏再同步治疗的患病率更高，左心室更大，MR比其他患者更严重。在手术过程中，38例（95.0%）患者在中心病变处植入了装置。所有CS患者均成功治疗，心输出量立即改善。在1年随访时，89.3%的患者MR≤2+，40.0%的患者为纽约心脏协会心功能Ⅰ级。尽管两组结果相似，但CS患者残余MR更大和致命性心律失常事件可能是由于逆向重构不足和炎症导致的左心室持续损伤。
结论
经导管缘对缘修复是治疗CS相关MR患者心力衰竭的有效方法；然而，该人群中对药物和心脏装置难治的心肌病需要仔细管理。
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