Reverse Myocardial Remodeling Following Valve Repair in Patients With Chronic Severe Primary Degenerative Mitral Regurgitation,JACC: Cardiovascular Imaging

当前位置： X-MOL 学术 › JACC Cardiovasc. Imaging › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Reverse Myocardial Remodeling Following Valve Repair in Patients With Chronic Severe Primary Degenerative Mitral Regurgitation
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2021-08-18 , DOI: 10.1016/j.jcmg.2021.07.007
Boyang Liu ₁ , Desley A H Neil ₂ , Moninder Bhabra ₃ , Ramesh Patel ₄ , Thomas A Barker ₄ , Nicolas Nikolaidis ₅ , J Stephen Billing ₅ , Manvir Hayer ₁ , Shanat Baig ₁ , Anna M Price ₁ , Ravi Vijapurapu ₁ , Thomas A Treibel ₆ , Nicola C Edwards ₇ , Richard P Steeds ₁

Affiliation

Objectives

The aims of this study were to quantify preoperative myocardial fibrosis using late gadolinium enhancement (LGE), extracellular volume fraction (ECV%), and indexed extracellular volume (iECV) on cardiac magnetic resonance; determine whether this varies following surgery; and examine the impact on postoperative outcomes.

Background

Myocardial fibrosis complicates chronic severe primary mitral regurgitation and is associated with left ventricular dilatation and dysfunction. It is not known if this nonischemic fibrosis is reversible following surgery or if it affects ventricular remodeling and patient outcomes.

Methods

A multicenter prospective study was conducted among 104 subjects with primary mitral regurgitation undergoing mitral valve repair. Cardiac magnetic resonance and cardiopulmonary exercise stress testing were performed preoperatively and ≥6 months after surgery. Symptoms were assessed using the Minnesota Living With Heart Failure Questionnaire.

Results

Mitral valve repair was performed for Class 2a indications in 65 patients and Class 1 indications in 39 patients. Ninety-three patients were followed up at 8.8 months (IQR: 7.4 months-10.6 months). Following surgery, there were significant reductions in both ECV% (from 27.4% to 26.6%; P = 0.027) and iECV (from 17.9 to 15.4 mL/m²; P < 0.001), but the incidence of LGE was unchanged. Neither preoperative ECV% nor LGE affected postoperative function, but iECV predicted left ventricular end-systolic volume index (β = 1.04; 95% CI: 0.49 to 1.58; P < 0.001) and left ventricular ejection fraction (β = −0.61; 95% CI: −1.05 to −0.18; P = 0.006). Patients with above-median iECV of ≥17.6 mL/m² had significantly larger postoperative values of left ventricular end-systolic volume index (30.5 ± 12.7 mL/m² vs 23.9 ± 8.0 mL/m²; P = 0.003), an association that remained significant in subcohort analyses of patients in New York Heart Association functional class I.

Conclusions

Mitral valve surgery results in reductions in ECV% and iECV, which are surrogates of diffuse myocardial fibrosis, and preoperative iECV predicts the degree of postoperative remodeling irrespective of symptoms. (The Role of Myocardial Fibrosis in Degenerative Mitral Regurgitation; NCT02355418)

中文翻译：

慢性重度原发性退行性二尖瓣关闭不全患者瓣膜修复后的反向心肌重塑

目标

本研究的目的是使用晚期钆增强 (LGE)、细胞外体积分数 (ECV%) 和心脏磁共振指数细胞外体积 (iECV) 来量化术前心肌纤维化；确定这是否在手术后发生变化；并检查对术后结果的影响。

背景

心肌纤维化使慢性严重原发性二尖瓣关闭不全复杂化，并与左心室扩张和功能障碍有关。目前尚不清楚这种非缺血性纤维化在手术后是否可逆，或者它是否会影响心室重塑和患者预后。

方法

在 104 名原发性二尖瓣关闭不全接受二尖瓣修复的受试者中进行了一项多中心前瞻性研究。术前和术后≥6个月进行心脏磁共振和心肺运动负荷测试。使用明尼苏达心力衰竭患者问卷评估症状。

结果

对 65 名患者的 2a 类适应症和 39 名患者的 1 类适应症进行二尖瓣修复。93 名患者在 8.8 个月时得到随访（IQR：7.4 个月-10.6 个月）。手术后，ECV%（从 27.4% 到 26.6%； P = 0.027）和 iECV（从 17.9 到 15.4 mL/m ²；P < 0.001）均显着降低，但 LGE 的发生率没有变化。术前 ECV% 和 LGE 均不影响术后功能，但 iECV 预测左心室收缩末期容积指数（β = 1.04；95% CI：0.49 至 1.58；P < 0.001）和左心室射血分数（β = -0.61；95% CI：-1.05 至 -0.18；P = 0.006）。^{高于中值 iECV ≥17.6 mL/m 2}的患者术后左心室收缩末期容积指数值显着增加（30.5 ± 12.7 mL/m ²对比 23.9 ± 8.0 mL/m ²；P = 0.003），在纽约心脏协会的患者亚组分析中，该关联仍然显着功能类 I。