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Echocardiographic Variables Associated with Transvalvular Gradient After a Transcatheter Edge-To-Edge Mitral Valve Repair
Journal of the American Society of Echocardiography ( IF 6.5 ) Pub Date : 2021-10-12 , DOI: 10.1016/j.echo.2021.09.015
Sandra Hadjadj 1 , Afonso B Freitas-Ferraz 1 , Amélie Paquin 1 , Zachary Rouleau 1 , Serge Simard 1 , Mathieu Bernier 1 , Kim O'Connor 1 , Erwan Salaun 1 , Philippe Pibarot 1 , Marie-Annick Clavel 1 , Josep Rodés-Cabau 1 , Jean-Michel Paradis 1 , Jonathan Beaudoin 1
Affiliation  

Background

Transcatheter edge-to-edge mitral valve repair may lead to a reduction in mitral valve area (MVA) and elevated mean transmitral gradient (TMG). The objectives of this study were to assess the value of baseline MVA by different imaging methods and to explore the associations between MVA indexed to body surface area or left ventricular forward stroke volume and postprocedural TMG.

Methods

Preprocedural echocardiographic images from 76 consecutive patients were retrospectively reviewed. MVA planimetry from two-dimensional (2D) transthoracic echocardiography (MVATTE), 2D transesophageal echocardiography in the transgastric view (MVA2D TEE), and three-dimensional (3D) transesophageal echocardiography (MVA3D) were measured. Postprocedural TMGs were assessed at 1 to 3 months and all-cause mortality at 1 year.

Results

Postprocedural mean TMG > 5 mm Hg was associated with a 3.42-fold (95% confidence interval [CI], 1.08–10.87; P = .04) increased risk for 1-year all-cause mortality. Patients with postprocedural TMG > 5 mm Hg (25% [19 of 76]) had significantly smaller preprocedural MVA3D (3.9 ± 0.8 vs 5.2 ± 1.3 cm2, P < .01) and MVATTE (4.9 ± 1.1 vs 5.8 ± 1.5 cm2, P = .01) compared with patients without elevated TMG. No significant difference was found for MVA2D TEE (P = .20). The best threshold values for MVA3D and MVATTE to be associated with postprocedural TMG > 5 mm Hg were, respectively, 3.9 cm2 (area under the curve [AUC] = 0.80; 95% CI, 0.66–0.94; sensitivity 62%, specificity 87%) and 4.6 cm2 (AUC = 0.68; 95% CI, 0.54–0.82; sensitivity 53%, specificity 80%). MVA3D indexed to body surface area and to stroke volume showed overall the best associations with postprocedural mean TMG > 5 mm Hg, with optimal thresholds, respectively, of 2.5 cm2/m2 (AUC = 0.88; 95% CI, 0.77–0.98; sensitivity 92%, specificity 74%) and 95 cm2/L (AUC = 0.87; 95% CI, 0.77–0.97; sensitivity 85%, specificity 82%).

Conclusions

Elevated TMG following transcatheter edge-to-edge mitral valve repair was associated with increased mortality. The present results indicate that MVA3D, MVA3D indexed to body surface area, and MVA3D indexed to stroke volume may be considered potential predictors of postprocedural TMG > 5 mm Hg and could help optimize patient selection, while the use of 2D methods for valve area were poorly associated with TMG.



中文翻译:

经导管边缘到边缘二尖瓣修复后与经瓣梯度相关的超声心动图变量

背景

经导管边缘到边缘二尖瓣修复可能导致二尖瓣面积 (MVA) 减少和平均二尖瓣梯度 (TMG) 升高。本研究的目的是通过不同的成像方法评估基线 MVA 的价值,并探索与体表面积或左心室前向每搏输出量相关的 MVA 与术后 TMG 之间的关联。

方法

回顾性回顾了 76 名连续患者的术前超声心动图图像。测量了二维 (2D) 经胸超声心动图 (MVA TTE )、经胃切面二维经食道超声心动图 (MVA 2D TEE ) 和三维 (3D) 经食道超声心动图 (MVA 3D ) 的 MVA 平面测量。在 1 至 3 个月评估术后 TMG,并在 1 年评估全因死亡率。

结果

 术后平均 TMG > 5 mm Hg 与1 年全因死亡率风险增加3.42 倍(95% 置信区间 [CI],1.08-10.87;P = .04)相关。术后 TMG > 5 mm Hg (25% [19 of 76]) 的患者术前 MVA 3D (3.9 ± 0.8 vs 5.2 ± 1.3 cm 2 , P  < .01) 和 MVA TTE (4.9 ± 1.1 vs 5.8 ± 1.5 ) 明显更小cm 2 , P  = .01) 与没有 TMG 升高的患者相比。MVA 2D TEE未发现显着差异( P  = .20)。MVA 3D和 MVA TTE的最佳阈值与术后 TMG > 5 mm Hg 相关的分别为 3.9 cm 2(曲线下面积 [AUC] = 0.80;95% CI,0.66-0.94;敏感性 62%,特异性 87%)和 4.6 cm 2(AUC = 0.68;95% CI,0.54–0.82;敏感性 53%,特异性 80%)。与体表面积和每搏输出量相关的MVA 3D总体显示与术后平均 TMG > 5 mm Hg 的最佳关联,最佳阈值分别为 2.5 cm 2 /m 2 (AUC = 0.88;95% CI, 0.77–0.98 ;敏感性 92%,特异性 74%)和 95 cm 2 /L(AUC = 0.87;95% CI,0.77–0.97;敏感性 85%,特异性 82%)。

结论

经导管边缘到边缘二尖瓣修复后 TMG 升高与死亡率增加有关。目前的结果表明,MVA 3D、MVA 3D与体表面积相关,以及 MVA 3D与每搏输出量相关,可能被认为是术后 TMG > 5 mm Hg 的潜在预测因子,有助于优化患者选择,而使用 2D 方法进行瓣膜面积与 TMG 的相关性较差。

更新日期:2021-10-12
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