BackgroundThe prognostic significance of intraprocedural pulsed‐wave Doppler analysis of pulmonary venous flow (PVF) during mitral transcatheter edge‐to‐edge repair (TEER) remains understudied. We aimed to investigate the prognostic value of systolic dominant‐PVF (SD‐PVF) morphology post‐TEER.MethodsIn a retrospective analysis from December 2019 to December 2022, patients undergoing mitral TEER were categorized into SD‐PVF and systolic blunting (SB)‐PVF groups based on post‐TEER morphology. The primary endpoint was a composite of all‐cause mortality or heart failure hospitalization at 1 year. We investigated the association of PVF morphology post‐TEER with the primary endpoint at 1 year using Cox regression and compared the prognostic accuracy of PVF variables through receiver operating characteristic (ROC) curve analysis.ResultsAmong 187 patients (mean age 76.4 ± 10.5 years, 51.3% primary etiology), residual mitral regurgitation (MR) ≤mild was observed in 147 (82.4%) patients and 105 (56.2%) had SD‐PVF post‐TEER. Patients with SD‐PVF had a lower incidence of >2+ residual MR after clip deployment, at 30 days (2.1% vs. 13.1%; p = 0.005) and at 1 year (1.4% vs. 9%; p = 0.08). SD‐PVF post‐TEER was independently associated with the primary endpoint (HR = 0.59, 95% CI = 0.39–0.87; p = 0.009). ROC curve analysis of the prognostic accuracy of SD‐PVF demonstrated an AUC of 0.64 (95% CI = 0.54–0.73), comparable to other quantitative measures of PVF.ConclusionAssessing PVF morphology after clip deployment offers a simple prognostic tool for patients undergoing mitral TEER. Multicenter cohorts will be necessary to further investigate its prognostic value.

中文翻译：

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收缩期主导肺静脉血流形态对二尖瓣经导管边对边修复术后结果的影响


背景二尖瓣经导管边对边修复术 (TEER) 期间肺静脉血流 (PVF) 的术中脉冲波多普勒分析的预后意义仍有待研究。我们的目的是探讨 TEER 后收缩期主导性 PVF (SD-PVF) 形态的预后价值。方法在 2019 年 12 月至 2022 年 12 月的回顾性分析中，接受二尖瓣 TEER 的患者分为 SD-PVF 和收缩期钝化 (SB)-基于 TEER 后形态的 PVF 组。主要终点是一年内全因死亡率或心力衰竭住院的综合终点。我们使用 Cox 回归研究了 TEER 后 PVF 形态与 1 年主要终点的关联，并通过受试者工作特征 (ROC) 曲线分析比较了 PVF 变量的预后准确性。 结果 187 名患者（平均年龄 76.4 ± 10.5 岁，51.3 岁） % 主要病因），在 147 名（82.4%）名患者中观察到残余二尖瓣反流（MR）≤轻度，其中 105 名（56.2%）在 TEER 后出现 SD-PVF。 SD-PVF 患者在夹子展开后 30 天（2.1% vs. 13.1%；p = 0.005）和 1 年（1.4% vs. 9%；p = 0.08）时 >2+ 残余 MR 发生率较低。 TEER 后 SD-PVF 与主要终点独立相关（HR = 0.59，95% CI = 0.39–0.87；p = 0.009）。 SD-PVF 预后准确性的 ROC 曲线分析表明，AUC 为 0.64（95% CI = 0.54-0.73），与 PVF 的其他定量测量结果相当。 结论 评估夹子展开后的 PVF 形态为接受二尖瓣 TEER 的患者提供了一种简单的预后工具。需要多中心队列来进一步研究其预后价值。