PDF(Pubmed)
Abstract：
Persisting iatrogenic atrial septal defects (iASD) after transcatheter mitral edge-to-edge repair (M-TEER) are associated with impaired outcomes. We investigated the natural history of relevant iASDs with left-to-right shunting post-M-TEER, predictors of spontaneous closure of iASD between 1 and 6 months post-M-TEER, and outcomes (heart failure [HF] hospitalization) in patients with spontaneous closure versus those with persistent iASD 6 months post-M-TEER. Patients with a relevant iASD 1-month post-M-TEER, who were treated conservatively in the randomized controlled MITHRAS trial, underwent clinical follow-up including transesophageal echocardiography 6 months post-M-TEER. Overall, 36 patients (median 77 [interquartile range 65-81] years; 36% women) completed the 6-months follow-up. Six (17%) patients had a spontaneous closure of the iASD. The eccentricity index of the iASD 1-month after M-TEER was the strongest predictor for spontaneous closure (Odds ratio 3.78; 95% confidence interval 1.26-11.33, p = 0.01) and an eccentricity index of < 1.9 provided a sensitivity of 77% at a specificity of 83% for iASD persistence (Area under the curve 0.83, p < 0.001) within 6-months post M-TEER.At follow-up, a numerical difference in the endpoint of HF hospitalization between the spontaneous closure and the residual shunt group (0% vs. 20%, p = 0.25) was observed. The eccentricity of the iASD was the strongest predictor for spontaneous closure at 1-months and an eccentricity index of < 1.9 is associated with a high persistence rate for 6 month after M-TEER. Clinical Trial Registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT03024268 Identifier: NCT03024268. a (red) is reflecting the mayor lengthwise dimension and b (blue) the mayor oblique dimension. The eccentricity index is calculated by dividing a through b. (Open circle) is depicting an example for a round iASD and (Open rhombus) an example for an eccentric iASD 1 month after M-TEER.
摘要：
经导管二尖瓣边缘到边缘修复术(M-TEER)后的医源性房间隔缺损(iASD)与预后受损相关我们调查了M-TEER后从左到右分流的相关iASD的自然史，在M-TEER后1至6个月间iASD自发闭合的预测因子，和结果（心力衰竭[HF]住院）的患者自发关闭与那些持续iASD后6个月M-TEER。M-TEER术后1个月有相关iASD的患者，在随机对照MITHRAS试验中接受保守治疗，M-TEER术后6个月接受临床随访，包括经食管超声心动图检查。总的来说,36名患者（中位数77[四分位数范围65-81]年；36％的女性）完成了6个月的随访。6名（17％）患者的iASD自发闭合。M-TEER后1个月iASD的偏心指数是自发闭合的最强预测指标（赔率比3.78；95％置信区间1.26-11.33，p=0.01），而<1.9的偏心指数在M-TEER后6个月内对iASD持久性的特异性为83％时提供了77％的敏感性（曲线下面积0.83，p<0.001）。在后续行动中,自发性闭合和残余分流组之间HF住院终点的数值差异(0%vs.20%,观察到p=0.25）。iASD的偏心是1个月时自发闭合的最强预测因子，偏心指数<1.9与M-TEER后6个月的高持续率相关。临床试验注册ClinicalTrials.govhttps://clinicaltrials.gov/ct2/show/NCT03024268标识符：NCT03024268。a（红色）反映市长的纵向尺寸，b（蓝色）反映市长的倾斜尺寸。偏心指数是通过将a除以b来计算的。（空心圆）描绘了圆形iASD的示例，而（空心菱形）是M-TEER后1个月的偏心iASD的示例。
