Background

Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR.

Methods

Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes.

Results

Overall, 1074 (69.1% male, 73.3 ± 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies.

Conclusion

TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.

中文翻译：

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经导管二尖瓣修复术治疗心房功能性二尖瓣关闭不全的临床和超声心动图结果

背景

对于左心室收缩功能正常且二尖瓣无器质性病变的患者，孤立性房颤可导致二尖瓣关闭不全（MR）。关于 Mitraclip 在心房功能性二尖瓣关闭不全 (AFMR) 患者中的结果的可用信息很少。我们旨在评估 AFMR 患者与心室功能性或退行性/混合性 MR 患者相比，使用 MitraClip 经导管二尖瓣修复 (TMVR) 的 12 个月临床和超声心动图结果。

方法

对所有接受 TMVR 并被纳入西班牙 Mitraclip 登记处的连续患者进行基于登记处的分析。MR 和 NYHA 功能等级的变化，以及包括全因死亡率和心力衰竭住院在内的综合终点是主要结果。

结果

总体而言，本报告分析了 1074 名（69.1% 男性，73.3 ± 10.2 岁）患者。48 名患者 (4.5%) 出现 AFMR。TMVR 后 AFMR 显着降低，手术成功率为 91.7%，这种降低持续 12 个月（p  < 0.001）。在我们的系列中，AFMR 患者在 6 个月和 12 个月的随访中显示出显着的功能改善（基线：NYHA III 70.8% IV 18.8% 与 1 年：NYHA III 21.7% IV 0%；p < 0.001）。TMVR 后第一年内无心力衰竭再入院生存率和全因死亡率为 74.9%。与其他病因相比，程序和临床结果以及 MR 的急性复发率和 1 年复发率相似。

结论

与心室功能性或退行性/混合性 MR 相比，AFMR 患者的 TMVR 在 MR 降低或临床结果方面没有显着差异。