Clinical characteristics of patients with MitraClip operation and predictors for the occurrence of afterload mismatch
10.3969/j.issn.1004-8812.2024.10.003
- VernacularTitle:二尖瓣钳夹术后发生后负荷不匹配的危险因素分析
- Author:
Xiao-Dong ZHUANG
1
;
Han WEN
;
Ri-Hua HUANG
;
Xing-Hao XU
;
Shao-Zhao ZHANG
;
Zhen-Yu XIONG
;
Xin-Xue LIAO
Author Information
1. 中山大学附属第一医院心血管内科,广东 广州 510080
- Keywords:
Transcatheter mitral valve repair(MitraClip);
Afterload mismatch;
Risk factors;
Logistic regression
- From:
Chinese Journal of Interventional Cardiology
2024;32(10):562-568
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the risk factors related to afterload mismatch(AM)after transcatheter mitral valve repair(MitraClip).Methods This was a retrospective cohort study.48 patients hospitalized in the Department of Cardiovascular Medicine,the First Affiliated Hospital of Sun Yat-sen University from December 2021 to December 2023,who underwent MitraClip due to severe mitral regurgitation(MR)were included.Preoperative clinical data,laboratory tests,and preoperative and postoperative color Doppler echocardiographic examination results of surgical patients were collected.AM was defined as the left ventricular ejection fraction(LVEF)decreased by 15％or more after surgery compared with the one before(dLVEF≤-15％).Patients were divided into AM group and non-AM group according to whether afterload mismatch occurred.Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative AM.Results Among 48 patients who underwent MitraClip,14 of them(29.2％)developed afterload-mismatched.For those without AM,their overall LVEF was improved after the operation;for patients in both AM group and non-AM group,their overall left ventricular end-diastolic diameter(LVEDd),left ventricular end-diastolic diameter volume index(LVEDVi)was reduced compared with the preoperative ones.Univariate regression analysis showed that C-reactive protein levels(OR 1.98,95％CI 1.02-3.83),platelets(OR 2.22,95％CI 1.08-4.53),systemic immune inflammation index(OR 1.96,95％CI 1.03-3.71)were associated with an increased risk of AM in patients undergoing MitraClip(all P＜0.05),while those with larger right atrial diameter(OR 0.35,95％CI 0.13-0.93)or moderate to severe tricuspid regurgitation(OR 0.19,95％CI 0.05-0.81)were less likely to develop into AM(both P＜0.05),which is still satisfied after adjustment.Conclusions For patients who underwent MitraClip,C-reactive protein levels,platelets and systemic immune inflammation index(SII)are associated with an increased risk of afterload mismatched,while those with larger right atrial diameter or moderate to severe tricuspid regurgitation were less likely to develop into AM.
