Mannina Carlo, Sharma Akarsh, Prakash Yash, Carbone Andreina, Bossone Eduardo, Tuttolomondo Antonino, Argulian Edgar, Khera Sahil, Melarcode-Krishnamoorthy Parasuram, Dangas George, Halperin Jonathan, Tang Gilbert H L, Sharma Samin, Kini Annapoorna, Stone Gregg W, Lerakis Stamatios
Division of Cardiology Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai New York NY USA.
Department of Internal Medicine University of Palermo Palermo Italy.
J Am Heart Assoc. 2025 Aug 5;14(15):e042016. doi: 10.1161/JAHA.125.042016. Epub 2025 Jul 17.
Atrial fibrillation (AF) and mitral regurgitation (MR) are closely linked, and one may worsen the other. We investigated the impact of baseline AF in patients with MR undergoing transcatheter edge-to-edge repair.
One-hundred-fifty-six consecutive patients with symptomatic heart failure (HF) undergoing mitral valve transcatheter edge-to-edge repair for severe MR were studied. The primary end point was the composite outcome of death or HF hospitalization. Transthoracic echocardiograms were performed at baseline and follow-up.
Mean age was 80.8±8.8 years and 82 (52.6%) patients were female. MR cause was primary in 69 (44.2%) and secondary in 87 (55.8%) patients. AF or atrial flutter was present in 59 (37.8%) patients at baseline. Mitral valve transcatheter edge-to-edge repair was successful (≤2+ MR) in 58 (98.3%) and 94 (96.9%) patients with and without AF respectively (=0.59). During median 12.5 months follow-up, the primary end point occurred in 64 patients (2-year Kaplan-Meier estimated rate 41.0%), including death in 16 patients (10.3%) and HF hospitalization in 57 patients (36.5%). Baseline AF remained a significant independent predictor of death or HF hospitalization (adjusted hazard ratio, 2.03 [95% CI, 1.12-3.69], =0.02). Left ventricular end-diastolic volume, left atrial volume, and right ventricular systolic pressure decreased during follow-up among patients in sinus rhythm but not among those in AF. AF was associated with an increased risk of severe MR recurrence (18.6% versus 8.2%, =0.05).
In patients with HF and severe MR treated with Mitral valve transcatheter edge-to-edge repair, baseline AF was associated with impaired right and left heart remodeling, more frequent MR recurrence, and more than doubling of the 2-year risk of death or HF hospitalization.
心房颤动（AF）与二尖瓣反流（MR）密切相关，二者可能相互恶化。我们研究了基线房颤对接受经导管缘对缘修复术的二尖瓣反流患者的影响。
对156例因严重二尖瓣反流接受二尖瓣经导管缘对缘修复术的有症状心力衰竭（HF）患者进行了研究。主要终点是死亡或心力衰竭住院的复合结局。在基线和随访时进行经胸超声心动图检查。
平均年龄为80.8±8.8岁，82例（52.6%）患者为女性。69例（44.2%）患者的二尖瓣反流病因是原发性的，87例（55.8%）患者是继发性的。59例（37.8%）患者在基线时存在房颤或房扑。二尖瓣经导管缘对缘修复术在有房颤和无房颤的患者中分别有58例（98.3%）和94例（96.9%）成功（≤2+二尖瓣反流）（P=0.59）。在中位12.5个月的随访期间，64例患者出现了主要终点（2年Kaplan-Meier估计发生率为41.0%），包括16例患者死亡（10.3%）和57例患者心力衰竭住院（36.5%）。基线房颤仍然是死亡或心力衰竭住院的显著独立预测因素（调整后的风险比为2.03[95%CI，1.12-3.69]，P=0.02）。在随访期间，窦性心律患者的左心室舒张末期容积、左心房容积和右心室收缩压下降，但房颤患者未下降。房颤与严重二尖瓣反流复发风险增加相关（18.6%对8.2%，P=0.05）。
在接受二尖瓣经导管缘对缘修复术治疗的心力衰竭和严重二尖瓣反流患者中，基线房颤与左右心重构受损、二尖瓣反流复发更频繁以及2年死亡或心力衰竭住院风险增加一倍以上相关。
