Alon Shechter, Mirae Lee, Danon Kaewkes, Vivek Patel, Ofir Koren, Tarun Chakravarty, Keita Koseki, Takashi Nagasaka, Sabah Skaf, Moody Makar, Raj R Makkar, Robert J Siegel
{"title":"二尖瓣瓣环钙化对二尖瓣经导管边对边修复术后疗效的影响","authors":"Alon Shechter, Mirae Lee, Danon Kaewkes, Vivek Patel, Ofir Koren, Tarun Chakravarty, Keita Koseki, Takashi Nagasaka, Sabah Skaf, Moody Makar, Raj R Makkar, Robert J Siegel","doi":"10.1161/CIRCINTERVENTIONS.123.013424","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR).</p><p><strong>Methods: </strong>We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70-86] years; 60.0% males; 51.8% with functional MR) who underwent an isolated, first-time intervention. Stratified by MAC extent per baseline transthoracic echocardiogram, the cohort was assessed for residual MR, functional status, all-cause mortality, heart failure hospitalizations, and mitral reinterventions post-procedure.</p><p><strong>Results: </strong>Patients with above-mild MAC (n=101; 10.4%) were older and more likely to be female, exhibited a greater burden of comorbidities, and presented more often with severe, primary MR. Procedural aspects and technical success rate were unaffected by MAC magnitude, as was the significant improvement from baseline in MR severity and functional status along the first postprocedural year. However, the persistence of above-moderate MR or functional classes III and IV at 1 year and the cumulative incidence of reinterventions at 2 years were overall more pronounced within the above-mild MAC group (significant MR or functional impairment, 44.7% versus 29.9%, <i>P</i>=0.060; reinterventions, 11.9% versus 6.2%, <i>P</i>=0.033; log-rank <i>P</i>=0.035). No link was demonstrated between MAC degree and the cumulative incidence or risk of mortality and mortality or heart failure hospitalizations. Differences in outcomes frequencies were mostly confined to the primary MR subgroup, in which patients with above-mild MAC also experienced earlier, more frequent 2-year heart failure hospitalizations (20.8% versus 9.6%; <i>P</i>=0.016; log-rank <i>P</i>=0.020).</p><p><strong>Conclusions: </strong>Mitral transcatheter edge-to-edge repair in patients with and without above-mild MAC is equally feasible and safe; however, its postprocedural course is less favorable among those with primary MR.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":null,"pages":null},"PeriodicalIF":6.1000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair.\",\"authors\":\"Alon Shechter, Mirae Lee, Danon Kaewkes, Vivek Patel, Ofir Koren, Tarun Chakravarty, Keita Koseki, Takashi Nagasaka, Sabah Skaf, Moody Makar, Raj R Makkar, Robert J Siegel\",\"doi\":\"10.1161/CIRCINTERVENTIONS.123.013424\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR).</p><p><strong>Methods: </strong>We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70-86] years; 60.0% males; 51.8% with functional MR) who underwent an isolated, first-time intervention. Stratified by MAC extent per baseline transthoracic echocardiogram, the cohort was assessed for residual MR, functional status, all-cause mortality, heart failure hospitalizations, and mitral reinterventions post-procedure.</p><p><strong>Results: </strong>Patients with above-mild MAC (n=101; 10.4%) were older and more likely to be female, exhibited a greater burden of comorbidities, and presented more often with severe, primary MR. Procedural aspects and technical success rate were unaffected by MAC magnitude, as was the significant improvement from baseline in MR severity and functional status along the first postprocedural year. However, the persistence of above-moderate MR or functional classes III and IV at 1 year and the cumulative incidence of reinterventions at 2 years were overall more pronounced within the above-mild MAC group (significant MR or functional impairment, 44.7% versus 29.9%, <i>P</i>=0.060; reinterventions, 11.9% versus 6.2%, <i>P</i>=0.033; log-rank <i>P</i>=0.035). No link was demonstrated between MAC degree and the cumulative incidence or risk of mortality and mortality or heart failure hospitalizations. Differences in outcomes frequencies were mostly confined to the primary MR subgroup, in which patients with above-mild MAC also experienced earlier, more frequent 2-year heart failure hospitalizations (20.8% versus 9.6%; <i>P</i>=0.016; log-rank <i>P</i>=0.020).</p><p><strong>Conclusions: </strong>Mitral transcatheter edge-to-edge repair in patients with and without above-mild MAC is equally feasible and safe; however, its postprocedural course is less favorable among those with primary MR.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2024-02-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.123.013424\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/18 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.123.013424","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:关于二尖瓣环钙化(MAC)对二尖瓣反流(MR)经导管边缘到边缘修复术疗效影响的数据有限:关于二尖瓣环钙化(MAC)对二尖瓣反流(MR)经导管边缘到边缘修补术结果影响的数据有限:我们回顾性分析了968名首次接受孤立介入治疗的患者(中位年龄79岁[四分位间范围70-86岁];60.0%为男性;51.8%患有功能性二尖瓣反流)。根据基线经胸超声心动图的 MAC 程度进行分层,对队列中的残余 MR、功能状态、全因死亡率、心力衰竭住院率和二尖瓣术后再介入情况进行评估:轻度以上二尖瓣置换术患者(n=101;10.4%)年龄较大,更可能是女性,合并症较多,更常见于严重的原发性 MR。手术方面和技术成功率不受 MAC 程度的影响,术后第一年的 MR 严重程度和功能状态与基线相比也有显著改善。然而,中度以上 MR 或功能 III 级和 IV 级在术后 1 年的持续情况以及术后 2 年再介入的累积发生率在轻度以上 MAC 组中总体上更为明显(明显 MR 或功能障碍,44.7% 对 29.9%,P=0.060;再介入,11.9% 对 6.2%,P=0.033;对数秩 P=0.035)。MAC程度与死亡率、死亡率或心力衰竭住院的累积发生率或风险之间没有关联。结果频率的差异主要局限于原发性MR亚组,其中轻度以上MAC患者的2年心衰住院时间更早、更频繁(20.8%对9.6%;P=0.016;对数秩P=0.020):二尖瓣经导管边缘对边缘修补术在轻度以上MAC患者和非轻度MAC患者中同样可行、安全;但在原发性MR患者中,其术后情况较差。
Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair.
Background: Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR).
Methods: We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70-86] years; 60.0% males; 51.8% with functional MR) who underwent an isolated, first-time intervention. Stratified by MAC extent per baseline transthoracic echocardiogram, the cohort was assessed for residual MR, functional status, all-cause mortality, heart failure hospitalizations, and mitral reinterventions post-procedure.
Results: Patients with above-mild MAC (n=101; 10.4%) were older and more likely to be female, exhibited a greater burden of comorbidities, and presented more often with severe, primary MR. Procedural aspects and technical success rate were unaffected by MAC magnitude, as was the significant improvement from baseline in MR severity and functional status along the first postprocedural year. However, the persistence of above-moderate MR or functional classes III and IV at 1 year and the cumulative incidence of reinterventions at 2 years were overall more pronounced within the above-mild MAC group (significant MR or functional impairment, 44.7% versus 29.9%, P=0.060; reinterventions, 11.9% versus 6.2%, P=0.033; log-rank P=0.035). No link was demonstrated between MAC degree and the cumulative incidence or risk of mortality and mortality or heart failure hospitalizations. Differences in outcomes frequencies were mostly confined to the primary MR subgroup, in which patients with above-mild MAC also experienced earlier, more frequent 2-year heart failure hospitalizations (20.8% versus 9.6%; P=0.016; log-rank P=0.020).
Conclusions: Mitral transcatheter edge-to-edge repair in patients with and without above-mild MAC is equally feasible and safe; however, its postprocedural course is less favorable among those with primary MR.
期刊介绍:
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.