Naser Jwan A, Massad Faysal, Scott Christopher G, Borlaug Barry A, Michelena Hector I, Simard Trevor J, Siontis Konstantinos C, Kennedy Austin M, Thaden Jeremy J, Pellikka Patricia A, Nkomo Vuyisile T, Eleid Mackram F, Pislaru Sorin V
The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
The Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2025 Jul;106(1):494-503. doi: 10.1002/ccd.31567. Epub 2025 May 4.
Incident atrial functional mitral regurgitation (AFMR) is associated with mortality. Transcatheter edge-to-edge repair (TEER) has shown effectiveness in improving MR and symptoms in AFMR, but previous studies lacked comparison to conservative management. We aimed to study the association of AFMR severity and mitral TEER with symptoms, heart failure hospitalizations (HFH) and all-cause mortality in moderate/severe AFMR.
Consecutive adults with moderate/severe AFMR managed conservatively or with TEER 2010-2023 were identified retrospectively. To ensure similar technique in evaluation in the two groups, variables were obtained from the closest transthoracic echocardiogram before TEER in the TEER group. In addition to multivariable analysis, the association of TEER (vs. conservative management) with HFH and mortality was assessed using propensity-score matched analyses; the propensity score was based on age, sex, EuroSCORE II, effective regurgitant orifice area, integrative MR severity, and NYHA class III/IV (vs. I/II).
Among 230 patients with moderate/severe AFMR [mean age 77; 56% females], 46 were managed with TEER. Severe (vs. moderate) AFMR was independently associated with baseline NYHA class III/IV (multivariable OR 2.18 [95% CI 1.13-4.26]) and HFH [multivariable HR 2.75 (95% CI 1.25-6.03)] but not mortality (p = 0.26). TEER improved MR to ≤ moderate in 93% but was not associated with lower HFH or death rates versus conservative management on multivariable or matched analysis. However, 1-year NYHA improved more with TEER versus conservative management in patients with baseline NYHA class III/IV (62% vs. 27%, p = 0.03). Rhythm control was associated with improved survival (HR 0.38 [0.15-0.98]).
AFMR severity was associated with symptoms and HFH but not mortality. MR severity and NYHA class improved with TEER, but the association of TEER with HF hospitalizations or death remains unproven. Randomized studies are needed to evaluate the potential role of TEER and rhythm control on outcomes in AFMR.
新发心房功能性二尖瓣反流（AFMR）与死亡率相关。经导管缘对缘修复术（TEER）已显示出在改善AFMR患者的二尖瓣反流及症状方面的有效性，但既往研究缺乏与保守治疗的比较。我们旨在研究中度/重度AFMR患者中AFMR严重程度及二尖瓣TEER与症状、心力衰竭住院（HFH）和全因死亡率之间的关联。
回顾性纳入2010年至2023年期间接受保守治疗或TEER治疗的连续成年中度/重度AFMR患者。为确保两组评估技术相似，TEER组的变量来自TEER术前最近的经胸超声心动图检查。除多变量分析外，使用倾向评分匹配分析评估TEER（与保守治疗相比）与HFH和死亡率之间的关联；倾向评分基于年龄、性别、欧洲心脏手术风险评估系统II（EuroSCORE II）、有效反流口面积、综合二尖瓣反流严重程度以及纽约心脏协会（NYHA）心功能分级III/IV级（与I/II级相比）。
在230例中度/重度AFMR患者（平均年龄77岁；56%为女性）中，46例接受了TEER治疗。重度（与中度相比）AFMR与基线NYHA心功能分级III/IV级（多变量比值比2.18 [95%置信区间1.13 - 4.26]）和HFH独立相关（多变量风险比2.75 [95%置信区间1.25 - 6.03]），但与死亡率无关（p = 0.26）。TEER使93%的患者二尖瓣反流改善至≤中度，但在多变量或匹配分析中，与保守治疗相比，TEER并未降低HFH或死亡率。然而，在基线NYHA心功能分级III/IV级的患者中，与保守治疗相比，TEER组1年时NYHA心功能改善更明显（62% vs. 27%，p = 0.03）。节律控制与生存率提高相关（风险比0.38 [0.15 - 0.98]）。
AFMR严重程度与症状和HFH相关，但与死亡率无关。TEER可改善二尖瓣反流严重程度和NYHA心功能分级，但TEER与HF住院或死亡之间的关联仍未得到证实。需要进行随机研究以评估TEER和节律控制在AFMR患者预后中的潜在作用。
