Takeuchi Makoto, Utsunomiya Hiroto, Tohgi Kiyotaka, Hamada Ayano, Hyodo Yohei, Tsuchiya Akane, Mogami Atsuo, Takemoto Hajime, Izumi Kanako, Takahari Kosuke, Ueda Yusuke, Itakura Kiho, Ikenaga Hiroki, Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Int J Cardiol Heart Vasc. 2025 Sep 15;61:101801. doi: 10.1016/j.ijcha.2025.101801. eCollection 2025 Dec.
Although no studies predict thrombotic events after mitral valve transcatheter edge-to-edge repair (MV-TEER), 34% of patients experience worsening spontaneous echocardiographic contrast (SEC) following MV-TEER. We hypothesized that predicting the SEC occurrence or rapid progression after MV-TEER and identifying associated cases would be valuable.
This retrospective study included 176 consecutive patients who underwent MV-TEER at Hiroshima University Hospital. SEC worsening was assessed using intraoperative transesophageal echocardiography pre- and post-procedure.
The study analyzed 168 patients undergoing MV-TEER (median age 80, 56 % male). Severe mitral regurgitation (MR), secondary MR, and atrial fibrillation were present in 67.5 %, 70.2 %, and 57.7 % (36.9 % paroxysmal) of patients, respectively. Overall, 149 patients (88 %) and 19 (12 %) had SEC grade ≤ 2 and SEC grade ≥ 3, respectively, considerably worsening post-MV-TEER in 30 %. Severe SEC or sludge (11 %) correlated with higher rates of non-paroxysmal atrial fibrillation (AF), cardiomyopathy, increased right atrial area index (RAAI), elevated atrial pressures, and reduced cardiac index. Multivariate analysis identified non-paroxysmal AF, RAAI, and preoperative SEC grade ≥ 3 as key predictors of severe SEC or sludge. Rapid SEC worsening (15 cases) was associated with non-paroxysmal AF, reduced left atrial strain, larger RAAI, and lower cardiac index. A predictive scoring model incorporating RAAI, left atrial strain, and cardiac index showed good discrimination (area under the curve: 0.79), aiding risk assessment for post-MV-TEER SEC progression.
Patients with non-paroxysmal AF, right atrial enlargement, reduced left atrial reservoir strain, or low cardiac index are at risk of rapid SEC worsening after MV-TEER, regardless of initial SEC grades.
尽管尚无研究预测二尖瓣经导管缘对缘修复术（MV - TEER）后血栓形成事件，但34%的患者在MV - TEER后出现自发超声心动图对比增强（SEC）恶化。我们推测，预测MV - TEER后SEC的发生或快速进展并识别相关病例将具有重要价值。
这项回顾性研究纳入了广岛大学医院连续176例行MV - TEER的患者。术中经食管超声心动图在手术前后评估SEC恶化情况。
该研究分析了168例行MV - TEER的患者（中位年龄80岁，56%为男性）。分别有67.5%、70.2%和57.7%（36.9%为阵发性）的患者存在严重二尖瓣反流（MR）、继发性MR和心房颤动。总体而言，149例患者（88%）的SEC分级≤2级，19例患者（12%）的SEC分级≥3级，30%的患者在MV - TEER后SEC明显恶化。严重SEC或血栓（11%）与非阵发性心房颤动（AF）、心肌病、右心房面积指数（RAAI）增加、心房压力升高和心脏指数降低的发生率较高相关。多因素分析确定非阵发性AF、RAAI和术前SEC分级≥3是严重SEC或血栓的关键预测因素。SEC快速恶化（15例）与非阵发性AF、左心房应变降低、RAAI增大和心脏指数降低相关。纳入RAAI、左心房应变和心脏指数的预测评分模型显示出良好的辨别能力（曲线下面积：0.79），有助于对MV - TEER后SEC进展进行风险评估。
无论初始SEC分级如何，非阵发性AF、右心房扩大、左心房储备应变降低或心脏指数低的患者在MV - TEER后有SEC快速恶化的风险。
