Mismatch Between Residual Mitral Regurgitation and Left Atrial Pressure Predicts Prognosis After Transcatheter Edge-to-Edge Repair

被引:2
作者
Shibahashi, Eiji [1 ]
Yamaguchi, Junichi [1 ]
Kawamoto, Takanori [1 ]
Yoshikawa, Masafumi [1 ]
Kogure, Tomohito [1 ]
Inagaki, Yusuke [1 ]
Koyanagi, Chihiro [1 ]
Otsuki, Hisao [1 ]
Yamamoto, Masanori [2 ,3 ,4 ]
Saji, Mike [5 ,6 ]
Kubo, Shunsuke [7 ]
Asami, Masahiko [8 ]
Nakashima, Masaki [9 ]
Enta, Yusuke [9 ]
Shirai, Shinichi [10 ]
Izumo, Masaki [11 ]
Mizuno, Shingo [12 ]
Watanabe, Yusuke [13 ]
Amaki, Makoto [14 ]
Kodama, Kazuhisa [15 ]
Nakajima, Yoshifumi [16 ]
Naganuma, Toru [17 ]
Bota, Hiroki [18 ]
Ohno, Yohei [19 ]
Yamawaki, Masahiro [20 ]
Ueno, Hiroshi [18 ,21 ]
Mizutani, Kazuki [22 ]
Otsuka, Toshiaki [23 ]
Hayashida, Kentaro [24 ]
机构
[1] Tokyo Womans Med Univ, Dept Cardiol, 8-1,Kawadacho,Shinjuku Ku, Tokyo 1620054, Japan
[2] Toyohashi Heart Ctr, Dept Cardiol, Toyohashi, Japan
[3] Nagoya Heart Ctr, Dept Cardiol, Nagoya, Japan
[4] Gifu Heart Ctr, Dept Cardiol, Gifu, Japan
[5] Sakakibara Heart Inst, Dept Cardiol, Tokyo, Japan
[6] Toho Univ, Fac Med, Dept Internal Med, Div Cardiovasc Med, Tokyo, Japan
[7] Kurashiki Cent Hosp, Dept Cardiol, Kurashiki, Japan
[8] Mitsui Mem Hosp, Div Cardiol, Tokyo, Japan
[9] Sendai Kosei Hosp, Dept Cardiol, Sendai, Japan
[10] Kokura Mem Hosp, Div Cardiol, Kitakyushu, Japan
[11] St Marianna Univ Sch Med Hosp, Div Cardiol, Kawasaki, Japan
[12] Shonan Kamakura Gen Hosp, Dept Cardiol, Kanagawa, Japan
[13] Teikyo Univ, Sch Med, Dept Cardiol, Tokyo, Japan
[14] Natl Cerebral & Cardiovasc Ctr, Dept Cardiol, Suita, Japan
[15] Saiseikai Kumamoto Hosp Cardiovasc Ctr, Div Cardiol, Kumamoto, Japan
[16] Iwate Med Univ, Dept Internal Med, Div Cardiol, Yahaba, Iwate, Japan
[17] New Tokyo Hosp, Dept Cardiol, Chiba, Japan
[18] Sapporo Higashi Tokushukai Hosp, Dept Cardiol, Sapporo, Japan
[19] Tokai Univ Sch Med, Dept Cardiol, Isehara, Japan
[20] Saiseikai Yokohama City Eastern Hosp, Dept Cardiol, Yokohama, Kanagawa, Japan
[21] Toyama Univ Hosp, Dept Internal Med 2, Toyama, Japan
[22] Kinki Univ, Dept Med, Div Cardiol, Fac Med, Osaka, Japan
[23] Nippon Med Sch, Dept Hyg & Publ Hlth, Tokyo, Japan
[24] Keio Univ, Dept Cardiol, Sch Med, Tokyo, Japan
关键词
hemodynamics; left atrial pressure; mitral regurgitation; transcatheter edge-to-edge repair;
D O I
10.1016/j.jcin.2024.07.046
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND The mechanism and impact of mismatch between residual mitral regurgitation (MR) and postprocedural left atrial pressure (LAP) after transcatheter edge-to-edge repair (TEER), which may adversely affect clinical outcome, is of great interest. OBJECTIVES This study aimed to examine the effect of hemodynamic mismatch after TEER on clinical outcomes in patients with heart failure due to severe MR and investigate the predictive factors for the mismatch using a prospective multicenter registry. METHODS We categorized 1,477 patients into optimal (residual MR grade <= 1 and postprocedural LAP <= 15 mm Hg), mismatched (residual MR grade >1 or postprocedural LAP >15 mm Hg), and poor (residual MR grade >1 and postprocedural LAP >15 mm Hg) groups and examined their prognosis. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. RESULTS There were 927 (62.7%), 459 (31.1%), and 91 (6.2%) patients categorized into optimal, mismatched, and poor groups, respectively. Cox regression analysis, referenced to the optimal group, revealed that the mismatched and poor groups exhibited a higher risk for the primary endpoint (HR: 1.55; 95% CI: 1.28-1.88; and HR: 1.95; 95% CI: 1.38-2.74, respectively). Six risk factors were identified as predictors of hemodynamic mismatch after TEER: body mass index, baseline left atrial volume index, atrial fibrillation, tricuspid annular plane systolic excursion value, preprocedural mean left atrial pressure, and postprocedural mean mitral valve pressure gradient. CONCLUSIONS Post-TEER hemodynamic mismatch between residual MR and postprocedural LAP was associated with a poor prognosis. Six readily accessible perioperative parameters predict the hemodynamic mismatch. (OCEAN-Mitral registry; UMIN000023653) (c) 2024 by the American College of Cardiology Foundation.
引用
收藏
页码:2126 / 2137
页数:12
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