Structural Heart最新文献

英文中文

Advancing the Contemporary Multidisciplinary Heart Valve Team: Update on Priorities for Clinicians and Programs 推进当代多学科心脏瓣膜团队：临床医生和项目优先事项的更新

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-01 DOI: 10.1016/j.shj.2025.100490

Sandra B. Lauck PhD , Connie Clark MSN , Sophie Offen MD, PhD , Erin Tang MSN , Stephanie Sellers PhD

The multidisciplinary heart team (MDT) has been foundational to the rapid advancement of treatment options for valvular heart disease (VHD). Initially designed to guide treatment decisions for patients with aortic stenosis and procedural success of transcatheter aortic valve implantation, the MDT was intended to provide a responsive mechanism to meet the needs of patients and programs. Some of the unintended consequences of guideline endorsement and regulatory requirements have diminished the perceived value and threatened the engagement of team members. To maintain its impact, the VHD MDT must evolve to reflect contemporary priorities. For patients with aortic stenosis, the concept of the MDT must expand to address the significant barriers to timely detection, diagnosis, and referral and leverage its expertise to increase program capacity to accelerate access to care. The comprehensive mitral and tricuspid valve clinical pathway is in its infancy. For this patient group, the membership of the core MDT must be strengthened by the addition of expertise to support imaging diagnostics and procedural guidance, specialty team members who can guide the individualized clinical management of complex VHD, enhanced coordination of care and patient-centered processes, and consideration of unanswered clinical concerns. A recalibrated perspective on the key principles guiding the MDT for clinicians and programs offers opportunities to make the most of lessons learned by promoting quality of care and building a VHD collective and culture that can meet patients’ needs along their journey of care while prioritizing a nimble, tailored, efficient, and high-impact approach.

多学科心脏团队（MDT）是快速发展瓣瓣膜心脏病（VHD）治疗方案的基础。MDT最初旨在指导主动脉瓣狭窄患者的治疗决策和经导管主动脉瓣置入术的成功，旨在提供一种响应机制，以满足患者和项目的需求。指南认可和法规要求的一些意想不到的后果已经降低了感知价值并威胁到团队成员的参与。为了保持其影响力，VHD MDT必须不断发展，以反映当代的优先事项。对于主动脉瓣狭窄患者，MDT的概念必须扩大，以解决及时发现、诊断和转诊的重大障碍，并利用其专业知识提高项目能力，加速获得护理。全面的二尖瓣和三尖瓣临床路径尚处于起步阶段。对于这一患者群体，核心MDT的成员必须通过增加专业知识来支持成像诊断和程序指导，专业团队成员可以指导复杂VHD的个性化临床管理，加强护理和以患者为中心的过程的协调，并考虑未解决的临床问题来加强。对临床医生和项目指导MDT的关键原则进行重新调整后，可以通过提高护理质量和建立VHD集体和文化来最大限度地吸取经验教训，从而满足患者在护理过程中的需求，同时优先考虑灵活、量身定制、高效和高影响力的方法。

{"title":"Advancing the Contemporary Multidisciplinary Heart Valve Team: Update on Priorities for Clinicians and Programs","authors":"Sandra B. Lauck PhD , Connie Clark MSN , Sophie Offen MD, PhD , Erin Tang MSN , Stephanie Sellers PhD","doi":"10.1016/j.shj.2025.100490","DOIUrl":"10.1016/j.shj.2025.100490","url":null,"abstract":"<div><div>The multidisciplinary heart team (MDT) has been foundational to the rapid advancement of treatment options for valvular heart disease (VHD). Initially designed to guide treatment decisions for patients with aortic stenosis and procedural success of transcatheter aortic valve implantation, the MDT was intended to provide a responsive mechanism to meet the needs of patients and programs. Some of the unintended consequences of guideline endorsement and regulatory requirements have diminished the perceived value and threatened the engagement of team members. To maintain its impact, the VHD MDT must evolve to reflect contemporary priorities. For patients with aortic stenosis, the concept of the MDT must expand to address the significant barriers to timely detection, diagnosis, and referral and leverage its expertise to increase program capacity to accelerate access to care. The comprehensive mitral and tricuspid valve clinical pathway is in its infancy. For this patient group, the membership of the core MDT must be strengthened by the addition of expertise to support imaging diagnostics and procedural guidance, specialty team members who can guide the individualized clinical management of complex VHD, enhanced coordination of care and patient-centered processes, and consideration of unanswered clinical concerns. A recalibrated perspective on the key principles guiding the MDT for clinicians and programs offers opportunities to make the most of lessons learned by promoting quality of care and building a VHD collective and culture that can meet patients’ needs along their journey of care while prioritizing a nimble, tailored, efficient, and high-impact approach.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 7","pages":"Article 100490"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Aims & Scope 目标及范围

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-01 DOI: 10.1016/S2474-8706(25)00281-7

引用次数: 0

CT Imaging for Valvular Interventions 心脏瓣膜介入的CT成像

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-01 DOI: 10.1016/j.shj.2025.100667

Dee Dee Wang MD , Pedro A. Villablanca MD , Kent Chak-Yu So MD , Robert J. Cubeddu MD , Brian P. O’Neill MD , William W. O’Neill MD

Physician-led computed tomography (CT) imaging for valvular interventions has directly contributed to the safety and scalability of transcatheter aortic valve interventions globally. As the shift of the global population’s valvular heart disease extends into the transcatheter aortic, mitral, pulmonic, and tricuspid space, CT imaging for valvular interventions in new anatomical pathophysiologies becomes more important than ever. Health systems dedicated to investing in physician-led structural heart imaging CT procedural planning expertise and transcatheter treatment advancements can bring life-saving innovative care to patients in need.

在全球范围内，医生主导的主动脉瓣介入的计算机断层扫描（CT）成像直接促进了经导管主动脉瓣介入的安全性和可扩展性。随着全球人口的心脏瓣膜疾病的转移延伸到经导管主动脉、二尖瓣、肺动脉和三尖瓣间隙，CT成像对新的解剖病理生理学的瓣膜干预变得比以往任何时候都更加重要。致力于投资于医生主导的心脏结构成像CT程序规划专业知识和经导管治疗进步的卫生系统可以为有需要的患者带来挽救生命的创新护理。

引用次数: 0

Simulation for Procedural Planning and Intracardiac Echo for Enhancing Precision in Cardiac Interventions With a Focus on Left Atrial Appendage Closure 以左心耳闭合为重点的心脏介入手术程序规划和心内回波模拟提高精度

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-07-01 DOI: 10.1016/j.shj.2025.100671

Jaya Chandrasekhar MBBS, MS, PhD , Jacqueline Saw MD

In recent years, structural interventions have explored three-dimensional printing and computer simulation technologies to facilitate optimal device selections for more efficient procedures with fewer patient complications. Cardiovascular procedures, both structural interventions and electrophysiological procedures, have examined the utility of intracardiac echocardiography. In this review, we will discuss the growth of these technologies and highlight recent studies with a key focus on left atrial appendage closure.

近年来，结构干预已经探索了三维打印和计算机模拟技术，以促进更有效的手术和更少的患者并发症的最佳设备选择。心血管手术，包括结构干预和电生理手术，已经检查了心内超声心动图的效用。在这篇综述中，我们将讨论这些技术的发展，并重点介绍最近在左心耳闭合方面的研究。

引用次数: 0

Reverse Remodeling Induced by Transcatheter Left Ventricular Restoration System Is Sustained Through 2 Years of Follow-Up 经导管左心室恢复系统诱导的反向重构持续2年的随访

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-30 DOI: 10.1016/j.shj.2025.100694

Alena Kurlianskaya MD, PhD , Michael L. Chuang MD , Oleg Polonetsky MD, PhD , Olesya Shatova MD , Jason R. Foerst MD , Kendra J. Grubb MD, MHA , Martin B. Leon MD , Ulrich P. Jorde MD , Mark Reisman MD , Daniel Burkhoff MD, PhD , AccuCinch Study Investigators

引用次数: 0

Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes 经导管主动脉瓣置换术后新窦冲洗时间与血流动力学结果

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-21 DOI: 10.1016/j.shj.2025.100686

Shivabalan Kathavarayan Ramu MD , Toshiaki Isogai MD, MPH , Saksham Beotra MS , Vishwum Kapadia , Nikita Thakore , Ankit Agrawal MD , Shashank Shekhar MD , Maryam Muhammad Ali Majeed-Saidan MD , Rohan Prasad MD , Agam Bansal MD , Abdelrahman Abushouk MD , Odette Iskandar MD , Larisa G. Tereshchenko MD, PhD , Grant Reed MD , Rishi Puri MD, PhD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Zoran Popovic MD , Amar Krishnaswamy MD , Samir R. Kapadia MD

Background

Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.

Methods

We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.

Results

At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, p = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, p = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, p = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.

Conclusions

Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.

背景：小叶血栓形成和经导管心脏瓣膜功能障碍是经导管主动脉瓣置换术（TAVR）后的关键问题。延长新窦冲洗时间（NWT）可能使患者易发生小叶减薄增厚（HALT）和小叶血栓形成，增加瓣膜退变的风险。本研究评估了tavr术后30天和1年，计算机视觉主动脉造影显示的体内NWT与血流动力学结果之间的关系。方法回顾性分析2016年至2020年期间接受球囊扩张瓣膜TAVR的2254例患者（平均年龄79±9岁，女性40%）。根据患者的NWTs分为T1组（1.444 ~ 1.870 s, n = 752）、T2组（1.870 ~ 1.939 s, n = 752）和T3组（1.939 ~ 2.110 s, n = 751）。结果30 d时，T3组经瓣主动脉瓣平均梯度高于T1组（12.61±5.07 mmHg vs. 11.98±4.75 mmHg, p = 0.03）。在多变量模型中，与T1相比，T3与主动脉瓣平均梯度增加显著相关（估计：0.703,p = 0.02）。30天时，HALT患者的NWT更高（1.970±0.047 s vs 1.889±0.100 s, p = 0.001）， NWT每增加0.1秒，发生HALT的几率增加三倍。结论延长的NWT与较高的经瓣梯度相关，独立预测tavr后HALT。NWT可以作为一种新的标志物来识别有瓣膜功能障碍风险的患者，并指导早期药物治疗。

{"title":"Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes","authors":"Shivabalan Kathavarayan Ramu MD , Toshiaki Isogai MD, MPH , Saksham Beotra MS , Vishwum Kapadia , Nikita Thakore , Ankit Agrawal MD , Shashank Shekhar MD , Maryam Muhammad Ali Majeed-Saidan MD , Rohan Prasad MD , Agam Bansal MD , Abdelrahman Abushouk MD , Odette Iskandar MD , Larisa G. Tereshchenko MD, PhD , Grant Reed MD , Rishi Puri MD, PhD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Zoran Popovic MD , Amar Krishnaswamy MD , Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100686","DOIUrl":"10.1016/j.shj.2025.100686","url":null,"abstract":"<div><h3>Background</h3><div>Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.</div></div><div><h3>Results</h3><div>At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, <em>p</em> = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, <em>p</em> = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, <em>p</em> = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.</div></div><div><h3>Conclusions</h3><div>Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100686"},"PeriodicalIF":2.8,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tricuspid Annulus Measurements in Severe Tricuspid Regurgitation: Comparative Analysis of Cardiac-Gated Computed Tomography Versus Three-Dimensional Transesophageal Echocardiography 重度三尖瓣反流的三尖瓣环测量：心脏门控计算机断层扫描与三维经食管超声心动图的比较分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-11 DOI: 10.1016/j.shj.2025.100679

Pranav Chandrashekar MD , Anas Zaqut MD , Raluca McCallum MD , Chara Rydzak MD, PhD , En-Ha Wu MD , Firas Zahr MD , Scott M. Chadderdon MD

Background

Treatment options for severe tricuspid regurgitation (TR) require a multimodal analysis of the tricuspid annulus (TA). Cardiac computed tomography (CT) is currently considered the gold standard for annular perimeter measurements, though three-dimensional transesophageal echocardiography (3D TEE) can yield similar results. As such, we sought to determine the accuracy and precision of 3D TEE imaging of the TA perimeter compared to CT imaging in outpatients with severe TR.

Methods

Fifty-five patients were referred for multimodality workup for severe TR that included CT and 3D TEE. The 3D TEE imaging was performed in the mid-esophageal (ME) and transgastric views. A semiautomated software program was used to identify and measure the TA with additional manual optimization by the reader. These 3D TEE measurements were compared to cardiac CT imaging.

Results

Out of 55 patients, 3 were excluded for hiatal hernias and 1 was excluded for severe kidney disease. Fifty-one studied patients had an average age of 76 ± 10 years with 59% female. The 3D TEE analysis of the TA perimeter demonstrated an excellent correlation with CT from the ME view, R = 0.88, and from the TG view, R = 0.86, with an average difference of approximately 8.5% when compared to CT. TEE inter-reader variability was approximately 6%, whereas CT variability was 1.4%

Conclusions

The 3D TEE TA perimeter measurements are accurate when compared to CT with a variability of 8.5%. While CT remains more precise, 3D TEE imaging for TA sizing should be considered a near-equivalent modality to CT.

背景：严重三尖瓣反流（TR）的治疗方案需要对三尖瓣环（TA）进行多模态分析。心脏计算机断层扫描（CT）目前被认为是环形周长测量的金标准，尽管三维经食管超声心动图（3D TEE）可以产生类似的结果。因此，我们试图确定与CT成像相比，门诊严重TR患者TA周缘3D TEE成像的准确性和精度。方法55例患者接受包括CT和3D TEE在内的严重TR多模式检查。在食管中位（ME）和经胃位进行三维TEE成像。使用半自动软件程序识别和测量TA，并由读者进行额外的手动优化。将这些3D TEE测量结果与心脏CT图像进行比较。结果55例患者中3例因裂孔疝被排除，1例因严重肾脏疾病被排除。51例患者平均年龄76±10岁，其中59%为女性。TA周长的3D TEE分析显示，从ME视图与CT具有良好的相关性，R = 0.88，从TG视图，R = 0.86，与CT相比平均差异约为8.5%。TEE阅读器间变异性约为6%，而CT变异性为1.4%。结论：与变异性为8.5%的CT相比，3D TEE TA周长测量是准确的。虽然CT仍然更精确，但3D TEE成像对于TA的大小应该被认为是与CT近乎等同的方式。

{"title":"Tricuspid Annulus Measurements in Severe Tricuspid Regurgitation: Comparative Analysis of Cardiac-Gated Computed Tomography Versus Three-Dimensional Transesophageal Echocardiography","authors":"Pranav Chandrashekar MD , Anas Zaqut MD , Raluca McCallum MD , Chara Rydzak MD, PhD , En-Ha Wu MD , Firas Zahr MD , Scott M. Chadderdon MD","doi":"10.1016/j.shj.2025.100679","DOIUrl":"10.1016/j.shj.2025.100679","url":null,"abstract":"<div><h3>Background</h3><div>Treatment options for severe tricuspid regurgitation (TR) require a multimodal analysis of the tricuspid annulus (TA). Cardiac computed tomography (CT) is currently considered the gold standard for annular perimeter measurements, though three-dimensional transesophageal echocardiography (3D TEE) can yield similar results. As such, we sought to determine the accuracy and precision of 3D TEE imaging of the TA perimeter compared to CT imaging in outpatients with severe TR.</div></div><div><h3>Methods</h3><div>Fifty-five patients were referred for multimodality workup for severe TR that included CT and 3D TEE. The 3D TEE imaging was performed in the mid-esophageal (ME) and transgastric views. A semiautomated software program was used to identify and measure the TA with additional manual optimization by the reader. These 3D TEE measurements were compared to cardiac CT imaging.</div></div><div><h3>Results</h3><div>Out of 55 patients, 3 were excluded for hiatal hernias and 1 was excluded for severe kidney disease. Fifty-one studied patients had an average age of 76 ± 10 years with 59% female. The 3D TEE analysis of the TA perimeter demonstrated an excellent correlation with CT from the ME view, R = 0.88, and from the TG view, R = 0.86, with an average difference of approximately 8.5% when compared to CT. TEE inter-reader variability was approximately 6%, whereas CT variability was 1.4%</div></div><div><h3>Conclusions</h3><div>The 3D TEE TA perimeter measurements are accurate when compared to CT with a variability of 8.5%. While CT remains more precise, 3D TEE imaging for TA sizing should be considered a near-equivalent modality to CT.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 10","pages":"Article 100679"},"PeriodicalIF":2.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Baseline Anteroposterior Mitral Annular Dimensions on Clinical Outcomes after MitraClip for Secondary Mitral Regurgitation 二尖瓣前后环基线尺寸对二尖瓣夹闭治疗继发性二尖瓣返流后临床结果的影响

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-01 DOI: 10.1016/j.shj.2025.100460

Jason H. Rogers MD , Thomas W. Smith MD , Jeroen J. Bax MD, PhD , Federico M. Asch MD , D. Scott Lim MD , Ningyan Wong MBBS , Janani Aiyer MS , William T. Abraham MD , JoAnn Lindenfeld MD , Michael J. Mack MD , Gregg W. Stone MD , Steven F. Bolling MD

Background

In the randomized Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT; NCT01626079) trial, mitral transcatheter edge-to-edge repair (M-TEER) improved clinical outcomes in patients with severe secondary mitral regurgitation (MR). A prior post hoc analysis from the COAPT trial showed that increasing anteroposterior mitral annular diameter (APMAD) was the sole independent echocardiographic predictor of the composite endpoint of death or heart failure hospitalizations (HFH) at 2 years. Given the relationship between the mitral annulus and leaflets, we examined the association of baseline APMAD with long-term clinical outcomes.

Methods

COAPT patients (n = 575) were stratified into tertiles by baseline APMAD as follows: small APMAD, medium APMAD, and large APMAD. APMAD was measured in the anteroposterior direction from the parasternal long-axis view at end-diastole and in the intercommissural direction from the apical two-chamber view.

Results

Patients with larger baseline APMAD were more often male and had fewer comorbidities, larger ventricles, and larger mitral orifice areas. At 2 years, there were no significant differences in MR severity and the composite endpoint of death or HFH in patients treated with M-TEER by baseline APMAD. In patients treated with guideline-directed medical therapy (GDMT) alone, there were no significant differences in MR severity, but the composite endpoint of death or HFH was higher in patients with the largest baseline APMADs. The treatment effect of M-TEER was consistent among APMAD tertiles (p_interaction = 0.87).

Conclusions

APMAD was a predictor of adverse outcomes in patients treated with GDMT alone. M-TEER reduced MR severity and the risk of death or HFH regardless of baseline APMAD compared with GDMT alone.

背景：米特拉普经皮治疗心力衰竭合并功能性二尖瓣反流(COAPT；NCT01626079)试验表明，二尖瓣经导管边缘到边缘修复（M-TEER）改善了严重继发性二尖瓣反流（MR）患者的临床结果。先前COAPT试验的事后分析显示，二尖瓣前后环直径（APMAD）的增加是2年死亡或心力衰竭住院（HFH）复合终点的唯一独立超声心动图预测因子。考虑到二尖瓣环和小叶之间的关系，我们研究了基线APMAD与长期临床结果的关系。方法575例scoapt患者按APMAD基线分为APMAD小组、APMAD中组和APMAD大组。APMAD在舒张末期胸骨旁长轴位测量正位方向，在根尖双腔位测量关节间方向。结果基线APMAD较大的患者多为男性，合并症较少，心室和二尖瓣面积较大。在2年时，采用M-TEER治疗的患者在MR严重程度和死亡或HFH的综合终点方面没有显著差异。在仅接受指南导向药物治疗（GDMT）的患者中，MR严重程度无显著差异，但基线APMADs最大的患者的死亡或HFH复合终点较高。M-TEER的处理效果在APMAD三萜中一致（p互作= 0.87）。结论sapmad是单独使用GDMT治疗患者不良结局的预测因子。与单独使用GDMT相比，M-TEER降低了MR严重程度和死亡或HFH的风险，无论基线APMAD如何。

{"title":"Impact of Baseline Anteroposterior Mitral Annular Dimensions on Clinical Outcomes after MitraClip for Secondary Mitral Regurgitation","authors":"Jason H. Rogers MD , Thomas W. Smith MD , Jeroen J. Bax MD, PhD , Federico M. Asch MD , D. Scott Lim MD , Ningyan Wong MBBS , Janani Aiyer MS , William T. Abraham MD , JoAnn Lindenfeld MD , Michael J. Mack MD , Gregg W. Stone MD , Steven F. Bolling MD","doi":"10.1016/j.shj.2025.100460","DOIUrl":"10.1016/j.shj.2025.100460","url":null,"abstract":"<div><h3>Background</h3><div>In the randomized Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT; <span><span>NCT01626079</span><svg><path></path></svg></span>) trial, mitral transcatheter edge-to-edge repair (M-TEER) improved clinical outcomes in patients with severe secondary mitral regurgitation (MR). A prior post hoc analysis from the COAPT trial showed that increasing anteroposterior mitral annular diameter (APMAD) was the sole independent echocardiographic predictor of the composite endpoint of death or heart failure hospitalizations (HFH) at 2 years. Given the relationship between the mitral annulus and leaflets, we examined the association of baseline APMAD with long-term clinical outcomes.</div></div><div><h3>Methods</h3><div>COAPT patients (n = 575) were stratified into tertiles by baseline APMAD as follows: small APMAD, medium APMAD, and large APMAD. APMAD was measured in the anteroposterior direction from the parasternal long-axis view at end-diastole and in the intercommissural direction from the apical two-chamber view.</div></div><div><h3>Results</h3><div>Patients with larger baseline APMAD were more often male and had fewer comorbidities, larger ventricles, and larger mitral orifice areas. At 2 years, there were no significant differences in MR severity and the composite endpoint of death or HFH in patients treated with M-TEER by baseline APMAD. In patients treated with guideline-directed medical therapy (GDMT) alone, there were no significant differences in MR severity, but the composite endpoint of death or HFH was higher in patients with the largest baseline APMADs. The treatment effect of M-TEER was consistent among APMAD tertiles (<em>p</em><sub>interaction</sub> = 0.87).</div></div><div><h3>Conclusions</h3><div>APMAD was a predictor of adverse outcomes in patients treated with GDMT alone. M-TEER reduced MR severity and the risk of death or HFH regardless of baseline APMAD compared with GDMT alone.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 6","pages":"Article 100460"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

72261 | Development of a Mitral Valve Digital Twin for Transcatheter Edge-to-Edge Repair 经导管边缘对边缘修复二尖瓣数字孪生体的研制

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-01 DOI: 10.1016/j.shj.2025.100560

Natalie Simonian , Sneha Vakamudi , Mark Pirwitz , Michael Sacks

引用次数: 0

72337 | Prognostic Value of Baseline Aortic Valve Gradient in Acute Heart Failure Patients Undergoing TAVR 基线主动脉瓣梯度对急性心力衰竭患者行TAVR的预后价值

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-06-01 DOI: 10.1016/j.shj.2025.100538

Karthik Vedantam , Christian Torres , Peter Eckman , Martin Leon , Nirat Beohar , Sri Mandava

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Structural Heart

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀