Using Transmitral Pressure Gradients and Residual Mitral Regurgitation to Optimize Outcome After Transcatheter Edge-to-Edge Repair

作者：Hiroshi Tsunamoto, Masanori Yamamoto, Ai Kagase, Takahiro Tokuda, Atsushi Sugiura, Tetsuro Shimura, Azusa Murata, Ryo Yamaguchi, Yuki Izumi, Mike Saji, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Hisao Otsuki, Toru Naganuma, Hiroki Bota, Yohei Ohno, Masahiro Yamawaki, Hiroshi Ueno, Gaku Nakazawa, Daisuke Hachinohe, Toshiaki Otsuka, Shunsuke Kubo, Rebecca T. Hahn, Kentaro Hayashida · 发表于：Journal of the American College of Cardiology · 年份：2025 · DOI：10.1016/j.jacc.2025.07.041 · 被引用次数：7 · 研究领域：Cardiac Valve Diseases and Treatments、Cardiovascular Function and Risk Factors、Pulmonary Hypertension Research and Treatments

BACKGROUND: Although reducing mitral regurgitation (MR) after mitral transcatheter edge-to-edge repair (M-TEER) improves outcomes, the impact of increased transmitral mean pressure gradient (TMPG) remains controversial. OBJECTIVES: This study aimed to evaluate the clinical significance of MR reduction and TMPG elevation in patients with functional mitral regurgitation (FMR) after M-TEER. METHODS: A total of 2,360 FMR patients were evaluated using postdischarge echocardiography after M-TEER. The relationship between TMPG and outcomes was assessed using spline analysis and group-based comparisons. Based on residual MR severity and TMPG, patients were categorized into 5 groups to assess the prognostic impact of postprocedural hemodynamics: MR ≤ mild and TMPG <5 mm Hg (n = 1,702), MR ≤ mild and TMPG ≥5 to <10 mm Hg (n = 164), moderate MR and TMPG <5 mm Hg (n = 361), moderate MR and TMPG ≥5 to <10 mm Hg (n = 71), and MR > moderate or TMPG 10 mm Hg (n = 62). The primary endpoint was all-cause death or heart failure hospitalization. RESULTS: The 2-year primary endpoint event rates increased progressively with higher TMPG, from 25.0% at 1 mm Hg to 47.0% at 6 mm Hg. In multivariable analysis, TMPG per 1 mm Hg increment was independently associated with the primary endpoint (HR: 1.10; 95% CI: 1.02-1.17; P = 0.008). Using MR ≤ mild as the reference, moderate MR was not linked to higher risk, whereas MR > moderate remained a significant predictor of primary endpoint. The patients with MR...