Department of Anesthesiology

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Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography.

TitleLeft ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography.
Publication TypeJournal Article
Year of Publication2019
AuthorsKim 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
JournalCatheter Cardiovasc Interv
Date Published2019 Feb 21
ISSN1522-726X
Abstract

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.

DOI10.1002/ccd.28147
Alternate JournalCatheter Cardiovasc Interv
PubMed ID30790417
Grant List1K23 HL140092-01 / / Foundation for the National Institutes of Health /
1R01HL128278-01 / / Foundation for the National Institutes of Health /