Prediction of Cardiovascular Events and Structural and Functional Remodeling of the Heart in Patients With Severe Mitral Regurgitation of Various Genesis Underwent Transcatheter Mitral Valve Repair "Edge-To-Edge".

IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologiya Pub Date : 2024-09-30 DOI:10.18087/cardio.2024.9.n2699
M I Makeev, M A Saidova, A A Safiullina, A E Komlev, I V Kuchin, M M Kantemirova, T E Imaev
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引用次数: 0

Abstract

Aim: To search for predictors of adverse cardiovascular events after edge-to-edge transcatheter mitral valve repair (TMVR) in patients with severe mitral regurgitation (MR) of various origins with an assessment of structural and functional remodeling of the heart and left ventricular (LV) contractile function.

Material and methods: The study included 73 patients (median age 71 [63; 80] years, 60.3% men) at a high surgical risk with severe MR of primary and secondary genesis, who underwent TMVR. The second-generation (58.9%) and fourth-generation (41.1%) clips were implanted. In addition to standard echocardiographic (EchoCG) indices, the parameters of left heart chamber longitudinal strain and LV myocardial function were assessed at baseline, on days 4-5, and at 6 and 12 months after the intervention. Also, the N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP) was assessed at baseline and on days 4-5 after TMVR.

Results: A significant decrease in MR was achieved during 12 months of follow-up. In the group with primary mitral regurgitation (PMR), MR decreased from 4.0 [3.4; 4.0] to 2.0 [1.5; 2.5] at one year of follow-up (p<0.001). In the group with secondary mitral regurgitation (SMR), MR decreased from 3.5 [3.0; 3.9] to 2.0 [2.0; 2.5] at 12 months of follow-up (p<0.001). This effect was associated with volumetric unloading of the left heart chambers evident as a significant decrease in the volumetric indices of the left chambers and an increase in the cardiac index. In the early postoperative period, the LV function was impaired as shown by decreases in the ejection fraction (EF), global longitudinal strain (GLS), LV myocardial function parameters, and an associated increase in NT-proBNP. By 12 months of follow-up, statistically significant improvements in global constructive work (GCW) and global work index (GWI) relative to baseline values were noted in both groups without significant changes in EF and LV GLS. A strong correlation was found between LV EF and GCW (r=0.812, p<0.001) and GWI (r=0.749, p<0.001). The overall survival was 89%, not differing between groups (p=0.72); the absence of hospitalization for decompensated heart failure (HF) was 79.5%, also without significant differences between the groups (p=0.78). According to multivariate regression analysis, the baseline GCW value was the strongest predictor of rehospitalization for decompensated HF (relative risk (RR) 0.997; 95% confidence interval (CI) 0.995-1.000; p=0.021) and the composite endpoint (CEP) (hospitalization for decompensated HF + all-cause mortality) (RR 0.998; 95% CI 0.996-1.000; p=0.033) in the cohort with PMR. In the group with SMR, the initial degree of MR was related with rehospitalization and the CEP (OR 12.252; 95% CI 2.125-70.651; p=0.005 and OR 16.098; 95% CI 2.944-88.044; p=0.001, respectively). The most significant predictor of overall mortality in the study population was the preoperative value of LV stroke volume (OR 0.824; 95% CI 0.750-0.906; p<0.001).

Conclusion: Edge-to-edge TMVR exerts a positive effect on the prognosis and structural and functional remodeling of the heart in patients with PMR and SMR. Myocardial function indices may be useful in assessing the LV contractile function in patients with severe MR of various origins. Identification of predictors for adverse cardiovascular events, including with new EchoCG technologies, may contribute to better patient stratification.

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对接受经导管二尖瓣瓣膜 "边缘到边缘 "修复术的各种成因严重二尖瓣反流患者的心血管事件及心脏结构和功能重塑进行预测。
目的:通过评估心脏结构和功能重塑情况以及左心室收缩功能,寻找各种原因导致的严重二尖瓣反流(MR)患者接受边缘对边缘经导管二尖瓣修复术(TMVR)后发生不良心血管事件的预测因素:研究纳入了73名接受TMVR的原发性和继发性重度MR高手术风险患者(中位年龄71 [63; 80]岁,60.3%为男性)。植入的是第二代(58.9%)和第四代(41.1%)夹子。除标准超声心动图(EchoCG)指标外,还在基线、介入治疗后第 4-5 天、6 个月和 12 个月评估了左心室纵向应变参数和左心室心肌功能。此外,还在基线和 TMVR 后第 4-5 天评估了前脑利钠肽 N 端片段(NT-proBNP):结果:在 12 个月的随访中,MR 明显下降。在原发性二尖瓣反流(PMR)组中,随访一年后,MR 从 4.0 [3.4; 4.0] 降至 2.0 [1.5; 2.5](p<0.001)。在继发性二尖瓣反流 (SMR) 组中,随访 12 个月时,MR 从 3.5 [3.0; 3.9] 降至 2.0 [2.0; 2.5](p<0.001)。这种效应与左心房的容积负荷减轻有关,左心房的容积指数显著下降,心脏指数上升。术后早期,左心室功能受损,表现为射血分数(EF)、整体纵向应变(GLS)和左心室心肌功能参数的下降,以及相关的 NT-proBNP 增加。随访 12 个月后,两组患者的全局建设性工作(GCW)和全局工作指数(GWI)与基线值相比均有统计学意义上的显著改善,但射血分数(EF)和左心室纵向应变(GLS)无明显变化。研究发现,左心室 EF 与 GCW(r=0.812,p<0.001)和 GWI(r=0.749,p<0.001)之间存在很强的相关性。总生存率为 89%,组间无显著差异(p=0.72);无失代偿性心衰(HF)住院率为 79.5%,组间也无显著差异(p=0.78)。根据多变量回归分析,在 PMR 组群中,基线 GCW 值是失代偿性 HF 再住院(相对风险 (RR) 0.997;95% 置信区间 (CI)0.995-1.000;p=0.021)和复合终点 (CEP) (失代偿性 HF 住院 + 全因死亡率)(RR 0.998;95% CI 0.996-1.000;p=0.033)的最强预测因子。在 SMR 组中,MR 的初始程度与再住院和 CEP 有关(OR 分别为 12.252;95% CI 2.125-70.651;p=0.005 和 OR 16.098;95% CI 2.944-88.044;p=0.001)。研究人群总死亡率的最重要预测因素是术前左心室搏出量(OR 0.824; 95% CI 0.750-0.906; p<0.001):边对边TMVR对PMR和SMR患者的预后、心脏结构和功能重塑有积极影响。心肌功能指数可能有助于评估各种原因导致的严重 MR 患者的左心室收缩功能。通过新的 EchoCG 技术等手段确定不良心血管事件的预测因素,有助于更好地对患者进行分层。
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来源期刊
Kardiologiya
Kardiologiya 医学-心血管系统
CiteScore
1.70
自引率
20.00%
发文量
94
审稿时长
3-8 weeks
期刊介绍: “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.
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