Impact of Proportionality of Secondary Mitral Regurgitation on Outcome After Transcatheter Mitral Valve Repair

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Orban, Mathias^1,2  Karam, Nicole³  Lubos, Edith⁴  Kalbacher, Daniel⁴  Braun, Daniel¹  Deseive, Simon¹  Neuss, Michael⁵  Butter, Christian⁵  Praz, Fabien⁶  Kassar, Mohammad⁶  Petrescu, Aniela⁷  Pfister, Roman⁸  Iliadis, Christos⁸  Unterhuber, Matthias⁹  Lurz, Philipp⁹  Thiele, Holger⁹  Baldus, Stephan⁸  von Bardeleben, Ralph Stephan⁷  Blankenberg, Stefan⁴  Massberg, Steffen^1,2  Windecker, Stephan⁶  Hausleiter, Joerg^1,2 

[1] Klinikum Univ Munchen, Med Klin & Poliklin 1, Munich, Germany

[2] Munich Heart Alliance, Partner Site German Ctr Cardiovasc Dis, Munich, Germany

[3] European Hosp Georges Pompidou & Paris Cardiovasc, Dept Cardiol, INSERM U970, Paris, France

[4] UKE Hamburg, Klin & Poliklin Allgemeine & Intervent Kardiol, Hamburg, Germany

[5] Herzzentrum Brandenburg, Med Hsch Brandenburg Theodor Fontane, Bernau, Germany

[6] Univ Klin Kardiol, Inselspital Bern, Bern, Switzerland

[7] Johannes Gutenberg Univ Mainz, Zentrum Kardiol, Mainz, Germany

[8] Univ Cologne, Dept Internal Med 3, Heart Ctr, Cologne, Germany

[9] Univ Leipzig, Dept Cardiol, Heart Ctr Leipzig, Leipzig, Germany

关键词: echocardiography;    heart failure;    MR proportionality;    secondary mitral regurgitation;    transcatheter mitral valve repair;   

DOI  :  10.1016/j.jcmg.2020.05.042

来源: Elsevier

【 摘 要 】

OBJECTIVES The purpose of this paper was to evaluate the impact of proportionality of secondary mitral regurgitation (SMR) in a large real-world registry of transcatheter edge-to-edge mitral valve repair (TMVr) BACKGROUND Differences in the outcomes of recent randomized trials of TMVr for SMR may be explained by the proportionality of SMR severity to left ventricular (LV) volume. METHODS The ratio of pre-procedural effective regurgitant orifice area (EROA) to LV end-diastolic volume (LVEDV) was retrospectively assessed in patients undergoing TMVr for severe SMR between 2008 and 2019 from the EuroSMR registry. A recently proposed SMR proportionality scheme was adapted to stratify patients according to EROA/LVEDV ratio in 3 groups: MR-dominant (MD), MR-LV-co-dominant (MLCD), and LV-dominant (LD). All-cause mortality was assessed as a primary outcome, secondary heart failure (HF) outcomes included hospitalization for HF (HHF), New York Heart Association (NYHA) functional class, N-terminal pro-B-type natriuretic peptide (NT-proBNP), 6-min-walk distance, quality of life and MR grade. RESULTS A total of 1,016 patients with an EROA/LVEDV ratio were followed for 22 months after TMVr. MR was reduced to grade <= 2+ in 92%, 96%, and 94% of patients (for MD, MLCD, and LD, respectively; p = 0.18). After adjustment for covariates including age, sex, diabetes, kidney function, body surface area, LV ejection fraction, and procedural MR reduction (grade <= 2+), adjusted rates of 2-year mortality in MD patients did not differ from those for MLCD patients (17% vs. 18%, respectively), whereas it was higher in LD patients (23%; p = 0.02 for comparison vs. MD+MLCD). The adjusted first HHF rate differed between groups (44% in MD, 56% in MLCD, 29% in LD; p = 0.01) as did the adjusted time for first death or HHF rate (66% in MD, 82% in MLCD, 68% in LD; p = 0.02). Improvement of NYHA functional class was seen in all groups (p < 0.001). Values for 6-min-walk distances, quality of life and NT-proBNP improved in most patients. CONCLUSIONS MD and MLCD patients had a comparable, adjusted 2-year mortality rate after TMVr which was slightly better than that of LD patients. Patients treated with TMVr had symptomatic improvement regardless of EROA/LVEDV ratio. (C) 2021 by the American College of Cardiology Foundation.

【 授权许可】

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