Background

There are conflicting results over the improvement rate and predictors of mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR).

Purpose

To define the cause, degree of improvement, and improvement predictors of moderate to severe mitral regurgitation in patients undergoing TAVR by using a simplified D-shaped mitral annulus model derived from multisection CT (MSCT).

Materials and Methods

This retrospective cohort study included 528 consecutive patients who underwent TAVR between April 2012 and October 2019. Patients with previous surgical aortic valve replacement and those with moderate or severe mitral stenosis were excluded. A total of 104 patients with moderate to severe mitral regurgitation met the inclusion criteria and were included in the final analysis. At least one grade reduction in the severity of mitral regurgitation was considered indicative of mitral regurgitation improvement after TAVR. Up to 5-year post-TAVR follow-up of mitral regurgitation improvement was evaluated. Mitral annular dimensions (annular area, circumference, and trigone-to-trigone, intercommissural, and anteroposterior distances) and annular calcification were assessed at MSCT with use of dedicated postprocessing software. Associations with mitral regurgitation improvement after TAVR were explored.

Results

A total of 104 patients with concomitant mitral regurgitation who underwent TAVR (mean age, 74 years ± 7; 61 men) were included in the study. Mitral regurgitation improved in 79 patients after TAVR and remained unchanged in the remaining 25 patients. Maximum improvement was observed in the 1st year after TAVR. D-shaped mitral annular parameters, including annular circumference (odds ratio [OR], 1.05; 95% CI: 1.01, 1.1; P = .02) and trigone-to-trigone (OR, 1.2; 95% CI: 1.03, 1.39; P = .02) and intercommissural (OR, 1.15; 95% CI: 1.02, 1.31; P = .02) distances, were related to mitral regurgitation improvement. In addition, patients with coronary artery disease had greater improvement in mitral regurgitation after TAVR (OR, 0.17; 95% CI: 0.04, 0.76; P = .02). Primary mitral regurgitation (OR, 5.1; 95% CI: 1.1, 24; P = .04) and D-shaped annular circumference (OR, 1.06; 95% CI: 1, 1.11; P = .04) were independent predictors of less mitral regurgitation improvement after TAVR.

Conclusion

Concomitant mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR) tends to improve after the procedure, with maximum improvement in the 1st year after TAVR. D-shaped annular circumference and primary mitral regurgitation were independent predictors of less mitral regurgitation improvement after TAVR.

© RSNA, 2021

Online supplemental material is available for this article.

See also the editorial by Collins in this issue.

中文翻译：

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CT二尖瓣环形状与经导管主动脉瓣置换术后二尖瓣关闭不全的关系

背景

在接受经导管主动脉瓣置换术 (TAVR) 的患者中，二尖瓣关闭不全的改善率和预测因素存在相互矛盾的结果。

目的

通过使用源自多节 CT (MSCT) 的简化 D 形二尖瓣环模型，确定接受 TAVR 的患者中重度二尖瓣返流的原因、改善程度和改善预测因素。

材料和方法

这项回顾性队列研究包括 528 名在 2012 年 4 月至 2019 年 10 月期间接受 TAVR 的连续患者。 既往接受过主动脉瓣置换术的患者以及中度或重度二尖瓣狭窄的患者被排除在外。共104例中重度二尖瓣关闭不全患者符合纳入标准，纳入最终分析。TAVR 后，二尖瓣关闭不全的严重程度至少降低一级被认为是二尖瓣关闭不全改善的指标。评估了长达 5 年的 TAVR 后二尖瓣关闭不全改善的随访。使用专用后处理软件在 MSCT 上评估二尖瓣环尺寸（环面积、周长和三角区到三角区、连合间和前后距离）和环钙化。

结果

共有 104 名接受 TAVR 的合并二尖瓣关闭不全患者（平均年龄，74 岁 ± 7；61 名男性）被纳入研究。TAVR 后 79 名患者的二尖瓣关闭不全改善，其余 25 名患者保持不变。在 TAVR 后的第一年观察到最大的改善。D 形二尖瓣环参数，包括瓣环周长（比值比 [OR]，1.05；95% CI：1.01，1.1；P = .02）和三角对三角（OR，1.2；95% CI：1.03，1.39） ；P = .02）和连合间（OR，1.15；95% CI：1.02, 1.31；P = .02）距离与二尖瓣关闭不全改善有关。此外，冠状动脉疾病患者在 TAVR 后二尖瓣关闭不全的改善更大（OR，0.17；95% CI：0.04, 0.76；P = .02）。原发性二尖瓣关闭不全 (OR, 5.1; 95% CI: 1.1, 24; P = .04) 和 D 形环周 (OR, 1.06; 95% CI: 1, 1.11; P = .04) 是较小的独立预测因子TAVR 后二尖瓣关闭不全改善。

结论

接受经导管主动脉瓣置换术 (TAVR) 的患者伴随的二尖瓣关闭不全在手术后趋于改善，在 TAVR 后的第 1 年改善最大。D 形环周和原发性二尖瓣关闭不全是 TAVR 后二尖瓣关闭不全改善较少的独立预测因素。

©北美放射学会，2021

本文提供了在线补充材料。

另请参阅 Collins 在本期中的社论。