Rogers Jason H, Smith Thomas W, Bax Jeroen J, Asch Federico M, Lim D Scott, Wong Ningyan, Aiyer Janani, Abraham William T, Lindenfeld JoAnn, Mack Michael J, Stone Gregg W, Bolling Steven F
Division of Cardiovascular Medicine, University of California, Davis Medical Center Sacramento, California, USA.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Struct Heart. 2025 Mar 20;9(6):100460. doi: 10.1016/j.shj.2025.100460. eCollection 2025 Jun.
In the randomized Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT; NCT01626079) trial, mitral transcatheter edge-to-edge repair (M-TEER) improved clinical outcomes in patients with severe secondary mitral regurgitation (MR). A prior post hoc analysis from the COAPT trial showed that increasing anteroposterior mitral annular diameter (APMAD) was the sole independent echocardiographic predictor of the composite endpoint of death or heart failure hospitalizations (HFH) at 2 years. Given the relationship between the mitral annulus and leaflets, we examined the association of baseline APMAD with long-term clinical outcomes.
COAPT patients (n = 575) were stratified into tertiles by baseline APMAD as follows: small APMAD, medium APMAD, and large APMAD. APMAD was measured in the anteroposterior direction from the parasternal long-axis view at end-diastole and in the intercommissural direction from the apical two-chamber view.
Patients with larger baseline APMAD were more often male and had fewer comorbidities, larger ventricles, and larger mitral orifice areas. At 2 years, there were no significant differences in MR severity and the composite endpoint of death or HFH in patients treated with M-TEER by baseline APMAD. In patients treated with guideline-directed medical therapy (GDMT) alone, there were no significant differences in MR severity, but the composite endpoint of death or HFH was higher in patients with the largest baseline APMADs. The treatment effect of M-TEER was consistent among APMAD tertiles ( = 0.87).
APMAD was a predictor of adverse outcomes in patients treated with GDMT alone. M-TEER reduced MR severity and the risk of death or HFH regardless of baseline APMAD compared with GDMT alone.
在“经皮二尖瓣夹合术治疗功能性二尖瓣反流心力衰竭患者的随机心血管结局评估（COAPT；NCT01626079）”试验中，二尖瓣经导管缘对缘修复术（M-TEER）改善了重度继发性二尖瓣反流（MR）患者的临床结局。COAPT试验先前的一项事后分析表明，二尖瓣前后径（APMAD）增加是2年时死亡或心力衰竭住院（HFH）复合终点的唯一独立超声心动图预测指标。鉴于二尖瓣环与瓣叶之间的关系，我们研究了基线APMAD与长期临床结局之间的关联。
将COAPT患者（n = 575）按基线APMAD分为三分位数，如下：小APMAD、中APMAD和大APMAD。在舒张末期从胸骨旁长轴视图在前后方向测量APMAD，并从心尖两腔视图在瓣间方向测量。
基线APMAD较大的患者男性居多，合并症较少，心室较大，二尖瓣口面积较大。在2年时，接受M-TEER治疗的患者中，按基线APMAD分层，MR严重程度以及死亡或HFH复合终点无显著差异。在仅接受指南指导的药物治疗（GDMT）的患者中，MR严重程度无显著差异，但基线APMAD最大的患者中死亡或HFH复合终点更高。M-TEER的治疗效果在APMAD三分位数之间是一致的（P = 0.87）。
APMAD是仅接受GDMT治疗患者不良结局的预测指标。与单独使用GDMT相比，无论基线APMAD如何，M-TEER均降低了MR严重程度以及死亡或HFH风险。
