Yasser M Sammour, Rody G Bou Chaaya, Taha Hatab, Syed Zaid, Joe Aoun, Omar M Makram, Priscilla Wessly, Sahar Samimi, Sherif F Nagueh, William A Zoghbi, Marvin D Atkins, Michael J Reardon, Nadeen Faza, Stephen H Little, Neal S Kleiman, Sachin S Goel
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Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]).</p><p><strong>Conclusions: </strong>Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. Exploration of reasons for elevated LAP after M-TEER and ways to lower it warrant further investigation.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e014055"},"PeriodicalIF":6.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair.\",\"authors\":\"Yasser M Sammour, Rody G Bou Chaaya, Taha Hatab, Syed Zaid, Joe Aoun, Omar M Makram, Priscilla Wessly, Sahar Samimi, Sherif F Nagueh, William A Zoghbi, Marvin D Atkins, Michael J Reardon, Nadeen Faza, Stephen H Little, Neal S Kleiman, Sachin S Goel\",\"doi\":\"10.1161/CIRCINTERVENTIONS.124.014055\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment.</p><p><strong>Methods: </strong>We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring. Patients were stratified into 3 groups according to tertiles of post-TEER mean LAP. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models.</p><p><strong>Results: </strong>We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]).</p><p><strong>Conclusions: </strong>Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. 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引用次数: 0
摘要
背景：左心房压力（LAP）升高与二尖瓣经导管边缘到边缘修补术（M-TEER）后的不良预后有关。我们试图根据最终夹片部署后测量的术后 LAP 差异来评估预后。方法：我们纳入了 2014-2022 年间在我院接受 M-TEER 并接受 LAP 监测的连续患者。根据TEER术后平均LAP的三等分将患者分为3组。采用 Kaplan-Meier 分析和 Cox 比例危险模型对结果进行评估。结果：我们共纳入了 273 名患者（平均年龄为 76.8±10.8 岁，42.5% 为女性，78.4% 为白种人）。分层 1（85 人）中，TEER 后 LAP 平均值为 8.7±1.7 mmHg；分层 2（95 人）中，LAP 平均值为 14.4±1.6 mmHg；分层 3（93 人）中，LAP 平均值为 21.9±3.8 mmHg。与三分层 1 相比，三分层 2 和三分层 3 与 2 年后全因死亡或心衰住院风险增加有关（adjHR 分别为 2.27，95% CI 1.25-4.12；adjHR 分别为 3.00，95% CI 1.59-5.64）。在原发性 MR 患者中，较高的 LAP 与 2 年全因死亡或心衰住院风险的增加有关（2 级与 1 级相比：adjHR 3.00，95% CI 1.37-6.56；3 级与 1 级相比：adjHR 5.52，95% CI 2.04-14.95）。然而，在继发性 MR 患者中，与三等分 1 相比，无论是三等分 2（adjHR 1.53；95% CI 0.55-4.24）还是三等分 3（adjHR 2.18；95% CI 0.82-5.77）都与综合结果无关。与未降低 LAP 相比，M-TEER 后任何程度的 LAP 降低均与较低的死亡率或心衰住院率相关（adjHR 0.59；95% CI 0.39-0.88）。结论M-TEER后LAP升高与2年死亡率或心衰住院风险增加有关。探索 M-TEER 后 LAP 升高的原因和降低 LAP 的方法值得进一步研究。
Impact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair.
Background: Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment.
Methods: We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring. Patients were stratified into 3 groups according to tertiles of post-TEER mean LAP. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazards models.
Results: We included 273 patients (mean age, 76.8±10.8 years; 42.5% women; 78.4% White). The mean post-TEER LAP was 8.7±1.7 mm Hg in tertile 1 (n=85), 14.4±1.6 mm Hg in tertile 2 (n=95), and 21.9±3.8 mm Hg in tertile 3 (n=93). In comparison with tertile 1, both tertiles 2 and 3 were associated with increased risk of all-cause mortality or heart failure hospitalization at 2 years (adjusted hazard ratio [adjHR], 2.27 [95% CI, 1.25-4.12] and adjHR, 3.00 [95% CI, 1.59-5.64], respectively). Among patients with primary mitral regurgitation, higher LAP was associated with increased risk of 2-year all-cause mortality or heart failure hospitalization (tertile 2 versus 1: adjHR, 3.00 [95% CI, 1.37-6.56]; tertile 3 versus 1: adjHR, 5.52 [95% CI, 2.04-14.95]). However, in patients with secondary mitral regurgitation, neither being in tertile 2 (adjHR, 1.53 [95% CI, 0.55-4.24]) nor tertile 3 (adjHR, 2.18 [95% CI, 0.82-5.77]) were associated with the composite outcome compared with tertile 1. Any degree of LAP reduction following M-TEER was associated with lower mortality or heart failure hospitalization compared with no LAP reduction (adjHR, 0.59 [95% CI, 0.39-0.88]).
Conclusions: Elevated LAP after M-TEER was associated with increased 2-year risk of mortality or heart failure hospitalization. Exploration of reasons for elevated LAP after M-TEER and ways to lower it warrant further investigation.
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.
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