Effect of Percutaneous Edge-to-Edge Repair on Mitral Valve Area and Its Association With Pulmonary Hypertension and Outcomes
Effect of Percutaneous Edge-to-Edge Repair on Mitral Valve Area and Its Association With Pulmonary Hypertension and Outcomes
复制标题
经皮边对边修复对二尖瓣区域的影响及其与肺动脉高压和结果的关系
DOI：
10.1016/j.amjcard.2017.05.036
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Shiota Takahiro
中科院分区：
文献类型：
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作者：
Utsunomiya Hiroto;Itabashi Yuji;Kobayashi Sayuki;Rader Florian;Hussaini Asma;Makar Moody;Trento Alfredo;Siegel Robert J.;Kar Saibal;Shiota Takahiro
使用MitraClip系统进行经皮缘对缘修复导致二尖瓣面积（MVA）减小。然而，其临床影响尚未完全阐明。本研究评估了术后MVA降低对肺动脉高压和结局的影响。回顾性分析了总计92例接受二尖瓣夹系统治疗的3级至4级+二尖瓣返流（MR）患者。使用术中三维经食管超声心动图，通过修复瓣膜内侧和外侧开口的2个优化平面获得术后MVA。二尖瓣夹系统手术后即刻MVA降低60.1%（p <0.001）。在大多数患者中，术后MVA与平均二尖瓣压力梯度（TMPG）中度相关（r=-0.56，p <0.001），但在40%的患者中观察到MVA和TMPG不一致。在多变量线性回归分析中，术后MVA ≤1.94 cm 2与1个月随访时肺动脉收缩压的钝性降低独立相关（β估计值−4.63，95%置信区间−9.71至−0.15，p = 0.042）。术后MVA ≤1.94 cm 2是MitraClip术后全因死亡率和心力衰竭住院的独立预测因子（风险比4.28，95%置信区间1.56 - 11.7，p = 0.005），即使调整了年龄、性别、房颤、二尖瓣返流原因、左心室收缩功能、既存肺动脉高压，在进一步调整TMPG ≥5 mm Hg后，术后MVA ≤1.94 cm 2仍可预测不良结局（p = 0.048）。总之，通过三维经食管超声心动图对MVA进行术中评估可预测二尖瓣夹系统治疗后的血流动力学反应和术后预后。
Percutaneous edge-to-edge repair using the MitraClip system causes reduction in mitral valve area (MVA). However, its clinical impact is not fully elucidated. This study assessed the impact of postprocedural MVA reduction on pulmonary hypertension and outcomes. A total of 92 patients with grades 3 to 4 + mitral regurgitation (MR) who underwent MitraClip therapy were retrospectively reviewed. Using intraprocedural, 3-dimensional transesophageal echocardiography, postprocedural MVA was obtained by 2 optimized planes through the medial and lateral orifices of the repaired valve. MVA was reduced by 60.1% immediately after MitraClip procedure (p <0.001). Postprocedural MVA correlated moderately with mean transmitral pressure gradient (TMPG) in the majority of patients (r= −0.56, p <0.001), but discordance of MVA and TMPG was observed in 40% of patients. In multivariable linear regression analysis, postprocedural MVA ≤1.94 cm2was independently associated with a blunted decrease in systolic pulmonary artery pressure at 1-month follow-up (β-estimate −4.63, 95% confidence interval −9.71 to −0.15, p = 0.042). Postprocedural MVA ≤1.94 cm2was an independent predictor of all-cause mortality and heart failure hospitalization after MitraClip (hazard ratio 4.28, 95% confidence interval 1.56 to 11.7, p = 0.005) even after adjustment for age, gender, atrial fibrillation, cause of MR, left ventricular systolic function, pre-existing pulmonary hypertension, and residual MR. After further adjustment for TMPG ≥5 mm Hg, postprocedural MVA ≤1.94 cm2remained predictive for adverse outcomes (p = 0.048). In conclusion, the intraprocedural assessment of MVA by 3-dimensional transesophageal echocardiography can predict hemodynamic response and postprocedural prognosis after MitraClip therapy.