经导管二尖瓣缘对缘修复术后残余反流与跨瓣压差对1年预后的影响
本研究基于CLASP IID随机试验284例患者，按出院时二尖瓣反流程度与平均跨瓣压差分组，比较1年超声与临床结局。结果显示72.5%达理想结果（MR≤1+且MVG≤5 mm Hg），其1年无主要不良事件率、生存率及复合终点率均显著高于次优结果组。次优结果中，MR≤1+且MVG>5 mm Hg者预后优于MR≥2+且MVG≤5 mm Hg者，提示优先消除反流较维持低压差更具临床获益。
要点
- M-TEER术后出院超声应同时记录残余MR分级与平均跨瓣压差
- 理想结果定义为MR≤1+且MVG≤5 mm Hg，与显著更低的1年不良事件相关
- 次优结果中优先实现MR≤1+即使MVG>5 mm Hg，预后仍优于残余MR≥2+者
核心结论
- 理想结果（MR≤1+且MVG≤5 mm Hg）与1年时显著更高的无主要不良事件率、生存率及复合终点率相关
- 次优结果中实现MR≤1+且MVG>5 mm Hg者，1年预后优于MR≥2+且MVG≤5 mm Hg者
- 在MR消除与维持低压差之间权衡时，优先优化MR的临床获益可能更大
研究设计与样本
- 研究类型为随机对照试验的术后亚组分析，数据来自CLASP IID试验
- 共284例患者有可用的出院超声心动图资料
- 按出院时残余MR分级与平均跨瓣压差分亚组进行比较
- 随访时间为1年
关键影像表现/征象
- 理想结果组患者肺静脉血流频谱与三尖瓣环收缩期位移显著改善
- 次优结果组包括MR≤1+且MVG>5 mm Hg、MR≥2+且MVG≤5 mm Hg、MR≥2+且MVG>5 mm Hg三种情况
诊断标准与关键数值
- 理想结果定义为出院时MR≤1+且MVG≤5 mm Hg，占72.5%（206/284）
- 次优结果定义为MR≤1+且MVG>5 mm Hg、MR≥2+且MVG≤5 mm Hg或MR≥2+且MVG>5 mm Hg，占27.5%（78/284）
- 理想结果组1年无主要不良事件率为89.5%，次优结果组为79.7%（P=0.023）
- 理想结果组1年无死亡率为94.1%，次优结果组为85.4%（P=0.016）
- 理想结果组1年无死亡、心衰住院或再干预复合终点率为88.6%，次优结果组为78.7%（P=0.022）
临床应用与阅片要点
- 术后出院超声报告应常规量化残余MR分级与平均跨瓣压差，以便识别理想与次优结果
- 次优结果患者中，存在残余MR≥2+者即使压差≤5 mm Hg，也应密切随访并考虑更积极的干预
- MVG>5 mm Hg但MR≤1+的患者1年预后仍较好，提示不应仅因压差偏高而过度担忧
局限性
- 为随机试验的亚组分析，次优结果组内分层后样本量进一步减小
- 根据出院时超声分组，未动态观察1年内MR与MVG的变化
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Reduction of mitral regurgitation (MR) in mitral transcatheter edge-to-edge repair (M-TEER) improves patient outcomes and is balanced against elevated mitral valve gradients (MVGs).
OBJECTIVES: This study sought to evaluate impact of residual MR and MVG on echocardiographic and clinical outcomes post-M-TEER.
METHODS: One-year outcomes from the randomized CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) were analyzed by discharge MR and MVG.
RESULTS: Of the 284 patients with available discharge echocardiogram, 72.5% (n = 206) achieved an optimal result (MR ≤1+ and MVG ≤5 mm Hg) and 27.5% (n = 78) achieved a suboptimal result (MR ≤1+ and MVG >5 mm Hg, MR ≥2+ and MVG ≤5 mm Hg, or MR ≥2+ and MVG >5 mm Hg). Optimal result patients had significantly improved pulmonary vein flow and tricuspid annular plane systolic excursion and experienced significantly higher freedom from major adverse events (MAEs) (89.5% vs 79.7%; P = 0.023), mortality (94.1% vs 85.4%; P = 0.016), and the composite of mortality, heart failure hospitalization, or reintervention (88.6% vs 78.7%; P = 0.022) at 1 year. Within suboptimal result patients, freedom from clinical events was higher with MR ≤1+ and MVG >5 mm Hg compared with MR ≥2+ and MVG ≤5 mm Hg at 1 year (MAEs: 87.7% vs 75.5%; mortality: 90.9% vs 84.6%; composite: 87.9% vs 72.5%).
CONCLUSIONS: In the CLASP IID trial, an optimal result was associated with improved hemodynamics with significantly higher freedom from MAEs, all-cause mortality, and composite events at 1 year. Within a suboptimal result, achieving MR ≤1+ and MVG >5 mm Hg demonstrated better 1-year prognosis compared with achieving MR ≥2+ and MVG ≤5 mm Hg, suggesting a clinical benefit of optimizing MR over preserving lower gradients. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833).
引用
- Narang, Hausleiter, Lim, et al. Impact of Residual Mitral Regurgitation and Gradient After M‑TEER: 1‑Year Outcomes From the CLASP IID Trial. JACC Cardiovasc Imaging. 2026. PMID: 42233921. doi:10.1016/j.jcmg.2026.04.005
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。