Kagase Ai, Yamamoto Masanori, Tokuda Takahiro, Kawahata Ryotaku, Nishio Hiroto, Shimura Tetsuro, Yamaguchi Ryo, Sago Mitsuru, Izumi Yuki, Saji Mike, Asami Masahiko, Enta Yusuke, Nakashima Masaki, Shirai Shinichi, Izumo Masaki, Mizuno Shingo, Watanabe Yusuke, Amaki Makoto, Kodama Kazuhisa, Yamaguchi Junichi, Naganuma Toru, Bouta Hiroki, Ohno Yohei, Yamawaki Masahiro, Ueno Hiroshi, Mizutani Kazuki, Hachinohe Daisuke, Otsuka Toshiaki, Kubo Shunsuke, Hayashida Kentaro
Department of Cardiology, Nagoya Heart Center, Nagoya, Japan.
Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
ESC Heart Fail. 2025 Apr 17. doi: 10.1002/ehf2.15295.
Plasma volume status (PVS) is recognized as a marker of systemic congestion, but its clinical utility in patients with mitral regurgitation (MR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) has not been well established. This study aimed to evaluate the prognostic significance of PVS in these patients.
Data from 3763 patients who underwent M-TEER were analysed from a Japanese multicentre registry. Patients were classified into functional MR (FMR) and degenerative MR (DMR) according to MR aetiology, and the median PVS values for each were calculated (FMR 12.7, DMR 14.4). The median value was used as the cut-off, stratifying the cohort into a high PVS group (n = 1882) and a low PVS group (n = 1881). All-cause mortality, cardiovascular death, and heart failure (HF) hospitalization between these two groups were compared up to 3 years in the overall, FMR, and DMR populations. The cumulative incidence rates of all-cause mortality, cardiovascular death, and HF hospitalization were higher in the high PVS group than in the low PVS group (47.0% vs. 22.2%, P < 0.001, 31.6% vs. 13.6%, P < 0.001, and 35.9% vs. 24.7%, P < 0.001, respectively). Similar trends in terms of all-cause mortality, cardiovascular death, and HF hospitalization were observed in the FMR and DMR cohorts (all P < 0.05). In the multivariate Cox regression analysis, the high PVS compared with the low PVS group was independently associated with the increased risk of all-cause death (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.03; P < 0.001), cardiovascular death (HR, 1.02; 95% CI, 1.01-1.03, P < 0.001) and HF hospitalization (HR, 1.02; 95% CI, 1.01-1.02, P < 0.001). An independent association between a high PVS and all-cause death, cardiovascular death, and HF hospitalization was also found in FMR and DMR sub-groups (all P < 0.05) while reducing MR severity to moderate or less after M-TEER was associated with improved outcomes in both the high and low PVS groups.
Preoperative PVS is a strong independent prognostic marker in patients undergoing M-TEER, correlating with increased risk of mortality and HF hospitalization. PVS may provide valuable clinical insights for patient stratification and management strategies in M-TEER patients.
血浆容量状态（PVS）被认为是全身充血的一个指标，但其在接受经导管二尖瓣缘对缘修复术（M-TEER）的二尖瓣反流（MR）患者中的临床应用尚未得到充分证实。本研究旨在评估PVS在这些患者中的预后意义。
对来自日本多中心注册研究的3763例行M-TEER的患者数据进行分析。根据MR病因将患者分为功能性MR（FMR）和退行性MR（DMR），并计算每组的PVS中位数（FMR为12.7，DMR为14.4）。以中位数作为临界值，将队列分为高PVS组（n = 1882）和低PVS组（n = 1881）。在总体、FMR和DMR人群中比较这两组在3年内的全因死亡率、心血管死亡和心力衰竭（HF）住院情况。高PVS组的全因死亡率、心血管死亡和HF住院的累积发生率均高于低PVS组（分别为47.0%对22.2%，P < 0.001；31.6%对13.6%，P < 0.001；35.9%对24.7%，P < 0.001）。在FMR和DMR队列中也观察到全因死亡率、心血管死亡和HF住院方面的类似趋势（均P < 0.05）。在多变量Cox回归分析中，与低PVS组相比，高PVS组与全因死亡风险增加独立相关（风险比[HR]，1.02；95%置信区间[CI]，1.01 - 1.03；P < 0.001）、心血管死亡（HR，1.02；95% CI，1.01 - 1.03，P < 0.001）和HF住院（HR，1.02；95% CI，1.01 - 1.02，P < 0.001）。在FMR和DMR亚组中也发现高PVS与全因死亡、心血管死亡和HF住院之间存在独立关联（均P < 0.05），而M-TEER后将MR严重程度降低至中度或更低与高PVS组和低PVS组的预后改善相关。
术前PVS是行M-TEER患者的一个强有力的独立预后标志物，与死亡风险和HF住院风险增加相关。PVS可为M-TEER患者的分层和管理策略提供有价值的临床见解。
