ACTA CARDIOLOGICA 好投吗-刊鹿论文编译

Clip therapy for secondary mitral regurgitation: the beginning of a long story?

Abstract:

Secondary mitral regurgitation (SMR) is the consequence of the mal-coaptation of the mitral valve leaflets, due to substantial alteration (mostly dilatation and flattening) of the mitral annulus geometry and/or an imbalance between closing and tethering forces [1]. SMR is a frequent clinical issue. Reported in up to 30% of heart failure patients, SMR is an independent marker associated with the risk of death or rehospitalisation [2]. MR itself worsens the left ventricular (LV) function and dilatation, hence increasing the MR’s severity, setting up a vicious circle. Therefore, in addition to amelioration of symptoms, it seems attractive to hypothesise that treating the MR could improve patient’s prognosis. Treatment of SMR was mainly based on optimal medical therapy, including cardiac resynchronisation therapy when appropriate [3]. A surgical treatment has been evaluated mainly in ischaemic heart diseases. The results are limited because of 1an important morbidity and mortality in patients with high surgical risk [4]; 2a high recurrence of MR after conservative surgery [5]; 3limited benefits in terms of survival and functional results essentially in the most ‘severe’ patients (e.g. cases with poorer left ventricular function) [6]. Thus, surgical treatment of SMR (mitral valve replacement mostly) is essentially restricted to lowerrisk patients having greater MR degree, and mainly when concomitant revascularization is feasible [3]. In the last decade, the MitraClip therapy emerged as an attractive treatment of MR: in the EVEREST II randomised trial, this percutaneous edge-to-edge repair showed similar improvements in clinical outcomes, with significantly superior safety (rate of blood transfusion and duration of mechanical ventilation), compared to surgery in 279 patients with symptomatic moderate to severe primitive or secondary MR [7]. Since this publication, long term worldwide results reported the persistence of the result at 5 years [8], as well as the safety of this technique in the hands of trained teams, even in high risk populations [9,10]. Interestingly, in a recent meta-analysis of 3253 patients treated by MitraClip therapy for SMR, a clear functional benefit has been reported. In addition, behind a reduction of the grade of the MR, a reverse left ventricular (LV) remodelling, and a reduction of pulmonary pressure, at follow-up, has been demonstrated. However, the prognosis of those treated patients remained poor with an 18% mortality at 12 months [11]. Another meta-analysis of 6 retrospective studies with a propensity-matched analysis showed that patients treated by MitraClip for a SMR had a better prognosis in term of mortality and re-hospitalization (median follow-up of 400-day), compared to patients treated by optimal medical treatment alone [12]. Based on these premises, the results of the two large multicenter randomised trials below were more than expected. The COAPT trial showed for the 1st time, on 614 patients, a clear benefit of a MitraClip therapy in SMR, on the top of an optimal medical therapy (OMT): the primary endpoint (all hospitalisations for heart failure within 24 months), was significantly reduced in the MitraClip group (HR 0.53; 95 CI 0.40-0.70; p> .001), with an impressive number needed to treat (NNT) of 3.1. It also showed a significant reduction of the allcause mortality in the MitraClip group (HR 0.62; 95 CI 0.46-0.82; p< .001), with a NNT of 5.9, as well as an improvement in quality of life, NYHA functional class, and functional parameters [13]. On the other hand, the MITRA-FR trial failed to show any 12-months clinical benefit of an additional MitraClip therapy on the top of an OMT, in 304 patients with severe symptomatic SMR [14].

Author Listing： Guillaume Leurent;Amedeo Anselmi;Erwan Donal

Volume： 75

Pages： 186 - 188

DOI： 10.1080/00015385.2019.1569314

Language： English

Journal： Acta Cardiologica

ACTA CARDIOLOGICA

ACTA CARDIOL

影响因子：2.1

是否综述期刊：否

是否OA：否

是否预警：不在预警名单内

发行时间：1946

ISSN：0001-5385

发刊频率：Bimonthly

收录数据库：SCIE/Scopus收录

出版国家/地区：BELGIUM

出版社：Acta Cardiologica

期刊介绍

Acta Cardiologica is an international journal. It publishes bi-monthly original, peer-reviewed articles on all aspects of cardiovascular disease including observational studies, clinical trials, experimental investigations with clear clinical relevance and tutorials.

Acta Cardiologica是一份国际期刊。它每两个月发表一次关于心血管疾病各个方面的原创、同行评审文章，包括观察性研究、临床试验、具有明确临床相关性的实验研究和教程。

年发文量	93
国人发稿量	26
国人发文占比	27.96%
自引率	38.1%
平均录取率	约75%
平均审稿周期	平均2月
版面费	-
偏重研究方向	医学-心血管系统
期刊官网	http://www.actacardiologica.be/
投稿链接	https://www.editorialmanager.com/AC

质量指标占比

研究类文章占比	OA被引用占比	撤稿占比	出版后修正文章占比
82.05%	4.53%	0.00%	0.79%

预警情况查看说明

时间	预警情况
2024年02月发布的2024版	不在预警名单中
2023年01月发布的2023版	不在预警名单中
2021年12月发布的2021版	不在预警名单中
2020年12月发布的2020版	不在预警名单中

JCR分区 WOS分区等级：Q3区

版本	按学科	分区
WOS期刊SCI分区 WOS期刊SCI分区是指SCI官方（Web of Science）为每个学科内的期刊按照IF数值排序，将期刊按照四等分的方法划分的Q1-Q4等级，Q1代表质量最高，即常说的1区期刊。（2021-2022年最新版）
	CARDIAC & CARDIOVASCULAR SYSTEMS	Q3

关于2019年中科院分区升级版（试行）

分区表升级版（试行）旨在解决期刊学科体系划分与学科发展以及融合趋势的不相容问题。由于学科交叉在当代科研活动的趋势愈发显著，学科体系构建容易引发争议。为了打破学科体系给期刊评价带来的桎梏，“升级版方案”首先构建了论文层级的主题体系，然后分别计算每篇论文在所属主题的影响力，最后汇总各期刊每篇论文分值，得到“期刊超越指数”，作为分区依据。

分区表升级版（试行）的优势：一是论文层级的主题体系既能体现学科交叉特点，又可以精准揭示期刊载文的多学科性；二是采用“期刊超越指数”替代影响因子指标，解决了影响因子数学性质缺陷对评价结果的干扰。整体而言，分区表升级版（试行）突破了期刊评价中学科体系构建、评价指标选择等瓶颈问题，能够更为全面地揭示学术期刊的影响力，为科研评价“去四唯”提供解决思路。相关研究成果经过国际同行的认可，已经发表在科学计量学领域国际重要期刊。

《2019年中国科学院文献情报中心期刊分区表升级版（试行）》首次将社会科学引文数据库（SSCI）期刊纳入到分区评估中。升级版分区表（试行）设置了包括自然科学和社会科学在内的18个大类学科。基础版和升级版（试行）将过渡共存三年时间，推测在此期间各大高校和科研院所仍可能会以基础版为考核参考标准。提示：中科院分区官方微信公众号“fenqubiao”仅提供基础版数据查询，暂无升级版数据，请注意区分。

中科院分区查看说明

版本	大类学科	小类学科	Top期刊	综述期刊
	医学 4区	CARDIAC & CARDIOVASCULAR SYSTEMS 心脏和心血管系统 4区	否	否
2021年12月基础版	医学 4区	CARDIAC & CARDIOVASCULAR SYSTEMS 心脏和心血管系统 4区	否	否
2021年12月升级版	医学 4区	CARDIAC & CARDIOVASCULAR SYSTEMS 心脏和心血管系统 4区	否	否
2020年12月旧的升级版	医学 4区	CARDIAC & CARDIOVASCULAR SYSTEMS 心脏和心血管系统 4区	否	否
2022年12月最新升级版	医学 4区	CARDIAC & CARDIOVASCULAR SYSTEMS 心脏和心血管系统 4区	否	否