Abstract：
BACKGROUND: The impact of intraprocedural results following transcatheter edge-to-edge repair (TEER) in primary mitral regurgitation (MR) is controversial.
OBJECTIVE: This study sought to investigate the prognostic impact of intraprocedural residual mitral regurgitation (rMR) and mean mitral valve gradient (MPG) in patients with primary MR undergoing TEER.
METHODS: The PRIME-MR (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation) registry included consecutive patients with primary MR undergoing TEER from 2008 to 2022 at 27 international sites. Clinical outcomes were assessed according to intraprocedural rMR and mean MPG. Patients were categorized according to rMR (optimal result: ≤1+, suboptimal result: ≥2+) and MPG (low gradient: ≤5 mm Hg, high gradient: > 5 mm Hg). The prognostic impact of rMR and MPG was evaluated in a Cox regression analysis. The primary endpoint was 2-year all-cause mortality or heart failure hospitalization.
RESULTS: Intraprocedural rMR and mean MPG were available in 1,509 patients (median age = 82 years [Q1-Q3: 76.0-86.0 years], 55.1% male). Kaplan-Meier analysis according to rMR severity showed significant differences for the primary endpoint between rMR ≤1+ (29.1%), 2+ (41.7%), and ≥3+ (58.0%; P < 0.001), whereas there was no difference between patients with a low (32.4%) and high gradient (42.1%; P = 0.12). An optimal result/low gradient was achieved in most patients (n = 1,039). The worst outcomes were observed in patients with a suboptimal result/high gradient. After adjustment, rMR ≥2+ was independently linked to the primary endpoint (HR: 1.87; 95% CI: 1.32-2.65; P < 0.001), whereas MPG >5 mm Hg was not (HR: 0.78; 95% CI: 0.47-1.31; P = 0.35).
CONCLUSIONS: Intraprocedural rMR but not MPG independently predicted clinical outcomes following TEER for primary MR. When performing TEER in primary MR, optimal MR reduction seems to outweigh the impact of high transvalvular gradients.
OBJECTIVE: This study sought to investigate the prognostic impact of intraprocedural residual mitral regurgitation (rMR) and mean mitral valve gradient (MPG) in patients with primary MR undergoing TEER.
METHODS: The PRIME-MR (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation) registry included consecutive patients with primary MR undergoing TEER from 2008 to 2022 at 27 international sites. Clinical outcomes were assessed according to intraprocedural rMR and mean MPG. Patients were categorized according to rMR (optimal result: ≤1+, suboptimal result: ≥2+) and MPG (low gradient: ≤5 mm Hg, high gradient: > 5 mm Hg). The prognostic impact of rMR and MPG was evaluated in a Cox regression analysis. The primary endpoint was 2-year all-cause mortality or heart failure hospitalization.
RESULTS: Intraprocedural rMR and mean MPG were available in 1,509 patients (median age = 82 years [Q1-Q3: 76.0-86.0 years], 55.1% male). Kaplan-Meier analysis according to rMR severity showed significant differences for the primary endpoint between rMR ≤1+ (29.1%), 2+ (41.7%), and ≥3+ (58.0%; P < 0.001), whereas there was no difference between patients with a low (32.4%) and high gradient (42.1%; P = 0.12). An optimal result/low gradient was achieved in most patients (n = 1,039). The worst outcomes were observed in patients with a suboptimal result/high gradient. After adjustment, rMR ≥2+ was independently linked to the primary endpoint (HR: 1.87; 95% CI: 1.32-2.65; P < 0.001), whereas MPG >5 mm Hg was not (HR: 0.78; 95% CI: 0.47-1.31; P = 0.35).
CONCLUSIONS: Intraprocedural rMR but not MPG independently predicted clinical outcomes following TEER for primary MR. When performing TEER in primary MR, optimal MR reduction seems to outweigh the impact of high transvalvular gradients.
摘要：
背景：经导管边缘到边缘修复（TEER）对原发性二尖瓣反流（MR）的术中结果的影响存在争议。
目的：本研究旨在探讨术中残余二尖瓣反流(rMR)和平均二尖瓣梯度(MPG)对接受TEER的原发性MR患者预后的影响。
方法：PRIME-MR（二尖瓣经导管边缘到边缘修复治疗原发性二尖瓣返流的患者的结果）登记包括2008年至2022年在27个国际站点接受TEER的连续原发性MR患者。根据术中rMR和平均MPG评估临床结果。根据rMR对患者进行分类（最佳结果：≤1+，次优结果：≥2+)和MPG(低梯度：≤5mmHg，高梯度：>5mmHg)。在Cox回归分析中评估了rMR和MPG的预后影响。主要终点是2年全因死亡率或心力衰竭住院。
结果：1,509例患者获得了术中rMR和平均MPG（中位年龄=82岁[Q1-Q3：76.0-86.0岁]，55.1%男性）。根据rMR严重程度的Kaplan-Meier分析显示，rMR≤1+（29.1%）之间的主要终点存在显著差异，2+（41.7%），≥3+(58.0%；P<0.001)，而低梯度（32.4％）和高梯度（42.1％；P=0.12）的患者之间没有差异。在大多数患者中实现了最佳结果/低梯度(n=1,039)。在结果欠佳/高梯度的患者中观察到最差的结果。调整后,rMR≥2+与主要终点独立相关(HR:1.87;95%CI:1.32-2.65;P<0.001),而MPG>5mmHg则没有(HR:0.78;95%CI:0.47-1.31;P=0.35)。
结论：术中rMR而非MPG独立预测原发性MRTEER后的临床结局。在主MR中执行TEER时，最佳的MR降低似乎超过了高跨瓣梯度的影响.
目的：本研究旨在探讨术中残余二尖瓣反流(rMR)和平均二尖瓣梯度(MPG)对接受TEER的原发性MR患者预后的影响。
方法：PRIME-MR（二尖瓣经导管边缘到边缘修复治疗原发性二尖瓣返流的患者的结果）登记包括2008年至2022年在27个国际站点接受TEER的连续原发性MR患者。根据术中rMR和平均MPG评估临床结果。根据rMR对患者进行分类（最佳结果：≤1+，次优结果：≥2+)和MPG(低梯度：≤5mmHg，高梯度：>5mmHg)。在Cox回归分析中评估了rMR和MPG的预后影响。主要终点是2年全因死亡率或心力衰竭住院。
结果：1,509例患者获得了术中rMR和平均MPG（中位年龄=82岁[Q1-Q3：76.0-86.0岁]，55.1%男性）。根据rMR严重程度的Kaplan-Meier分析显示，rMR≤1+（29.1%）之间的主要终点存在显著差异，2+（41.7%），≥3+(58.0%；P<0.001)，而低梯度（32.4％）和高梯度（42.1％；P=0.12）的患者之间没有差异。在大多数患者中实现了最佳结果/低梯度(n=1,039)。在结果欠佳/高梯度的患者中观察到最差的结果。调整后,rMR≥2+与主要终点独立相关(HR:1.87;95%CI:1.32-2.65;P<0.001),而MPG>5mmHg则没有(HR:0.78;95%CI:0.47-1.31;P=0.35)。
结论：术中rMR而非MPG独立预测原发性MRTEER后的临床结局。在主MR中执行TEER时，最佳的MR降低似乎超过了高跨瓣梯度的影响.
