Early Effect of Transcatheter Mitral Valve Repair on Cardiac Sympathetic Nerve Activity

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Structural Heart Pub Date : 2023-05-01 DOI:10.1016/j.shj.2022.100153
Hiroaki Yokoyama MD, Koki Shishido MD, Shingo Mizuno MD, Futoshi Yamanaka MD, Shigeru Saito MD
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Abstract

Background

Cardiac sympathetic nerve activity (SNA) is overactivated in heart failure patients and associated with clinical outcomes. The aim of this study is to investigate the early effect of MitraClip repair on cardiac SNA.

Methods

We evaluated the change of cardiac SNA by 123I- meta-iodobenzylguanidine (MIBG) scintigraphy in patients who underwent MitraClip repair from March 2019 to June 2020 in our hospital. Patients without acute procedural success were excluded, including patients who died or underwent mitral valve surgery before discharge. MIBG scintigraphy was performed at baseline and 1 ​month after MitraClip repair.

Results

We analyzed 48 patients (mean age 78.6 ± 10 years; 52.1% male; 37 secondary mitral regurgitation [SMR]/11 primary mitral regurgitation [PMR]). MR severity and New York Heart Association functional class significantly improved from baseline to 1 ​month after MitraClip repair (both p < 0.001). Overall, delay heart-mediastinum ratio (H/M) had no significant change, and washout rate (WR) showed a decreasing trend (delay H/M; pre 2.07 ± 0.46, post 2.05 ± 0.49, paired p = 0.348, WR; pre 36.1 ± 11.6%, post 33.6 ± 11.7%, paired p = 0.061). In PMR patients, WR was significantly decreased, however, delay H/M was not (delay H/M; pre 2.15 ± 0.50, post 2.10 ± 0.57, paired p = 0.019, WR; pre 34.6 ± 10.5%, post 26.7 ± 13.8%, paired p = 0.568). In contrast, in SMR patients, neither delay H/M nor WR were significantly changed (delay H/M; pre 2.05 ± 0.45, post 2.03 ± 0.47, paired p = 0.474, WR; pre 36.6 ± 11.9%, post 35.7 ± 10.4%, paired p = 0.523).

Conclusions

Our study demonstrates that MitraClip repair could significantly decrease cardiac SNA of WR in PMR patients during 1-month follow-up, however, in SMR patients, the significant change of MIBG parameters was not observed.

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经导管二尖瓣修复术对心脏交感神经活动的早期影响
心脏交感神经活动(SNA)在心力衰竭患者中被过度激活,并与临床结果相关。本研究的目的是研究MitraClip修复对心脏SNA的早期影响。方法我们通过123I-间碘苄基胍(MIBG)闪烁扫描评估了2019年3月至2020年6月在我院接受MitraClib修复的患者的心脏SNA变化。没有急性手术成功的患者被排除在外,包括出院前死亡或接受二尖瓣手术的患者。MIBG闪烁扫描在基线和1​MitraClip修复后一个月。结果我们分析了48例患者(平均年龄78.6±10岁;52.1%为男性;37例为继发性二尖瓣反流[SMR]/11例为原发性二尖瓣返流[PMR])。MR严重程度和纽约心脏协会功能分级从基线显著改善到1​MitraClip修复后一个月(均p<0.001)。总体而言,延迟性心脏纵隔比(H/M)没有显著变化,冲洗率(WR)呈下降趋势(延迟性H/M;2.07±0.46前,2.05±0.49后,配对p=0.348,WR;36.1±11.6%前,33.6±11.7%后,配对p=0.061)。然而,在PMR患者中,WR显著降低,延迟H/M没有(延迟H/M;前2.15±0.50,后2.10±0.57,配对p=0.019,WR;前34.6±10.5%,后26.7±13.8%,配对p=0.068)。相反,在SMR患者中,延迟H/M和WR均无显著变化(延迟H/M;2.05±0.45前,2.03±0.47后,配对p=0.474,WR;36.6±11.9%,35.7±10.4%,配对p=0.523),未观察到MIBG参数的显著变化。
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来源期刊
Structural Heart
Structural Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.60
自引率
0.00%
发文量
81
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