|Title||Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography.|
|Publication Type||Journal Article|
|Year of Publication||2019|
|Authors||Kim J, Alakbarli J, Palumbo MChiara, Xie LX, Rong LQ, Tehrani NH, Brouwer LR, Devereux RB, Wong SChiu, Bergman GW, Khalique OK, Levine RA, Ratcliffe MB, Weinsaft JW|
|Journal||Catheter Cardiovasc Interv|
|Date Published||2019 Feb 21|
OBJECTIVES: To assess impact of left ventricular (LV) chamber remodeling on MitraClip (MClp) response.
BACKGROUND: MitraClip is the sole percutaneous therapy approved for mitral regurgitation (MR) but response varies. LV dilation affects mitral coaptation; determinants of MClp response are uncertain.
METHODS: LV and mitral geometry were quantified on pre- and post-procedure two-dimensional (2D) transthoracic echocardiography (TTE) and intra-procedural three-dimensional (3D) transesophageal echocardiography (TEE). Optimal MClp response was defined as ≤mild MR at early (1-6 month) follow-up.
RESULTS: Sixty-seven degenerative MR patients underwent MClp: Whereas MR decreased ≥1 grade in 94%, 39% of patients had optimal response (≤mild MR). Responders had smaller pre-procedural LV end-diastolic volume (94 ± 24 vs. 109 ± 25 mL/m , p = 0.02), paralleling smaller annular diameter (3.1 ± 0.4 vs. 3.5 ± 0.5 cm, p = 0.002), and inter-papillary distance (2.2 ± 0.7 vs. 2.5 ± 0.6 cm, p = 0.04). 3D TEE-derived annular area correlated with 2D TTE (r = 0.59, p < 0.001) and was smaller among optimal responders (12.8 ± 2.1 cm vs. 16.8 ± 4.4 cm , p = 0.001). Both 2D and 3D mitral annular size yielded good diagnostic performance for optimal MClp response (AUC 0.73-0.84, p < 0.01). In multivariate analysis, sub-optimal MClp response was associated with LV end-diastolic diameter (OR 3.10 per-cm [1.26-7.62], p = 0.01) independent of LA size (1.10 per-cm [1.02-1.19], p = 0.01); substitution of mitral annular diameter for LV size yielded an independent association with MClp response (4.06 per-cm [1.03-15.96], p = 0.045).
CONCLUSIONS: Among degenerative MR patients undergoing MClp, LV and mitral annular dilation augment risk for residual or recurrent MR, supporting the concept that MClp therapeutic response is linked to sub-valvular remodeling.
|Alternate Journal||Catheter Cardiovasc Interv|
|Grant List||1K23 HL140092-01 / / Foundation for the National Institutes of Health / |
1R01HL128278-01 / / Foundation for the National Institutes of Health /