RELATIONSHIP OF RIGHT AND LEFT ATRIAL VOLUMES TO OUTCOMES FOLLOWING TRANSCATHETER MITRAL VALVE REPAIR

2020 ◽  
Vol 75 (11) ◽  
pp. 1213
Author(s):  
Matthew Miller ◽  
Jamey Cutts ◽  
Kajal Shah ◽  
Marissa Donatelle ◽  
Fardous Abeya ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Relationship Of

scholarly journals EFFECT OF TRANSCATHETER MITRAL VALVE REPAIR ON LEFT ATRIAL KINETIC ENERGY IN CHRONIC MITRAL REGURGITATION

2021 ◽  
Vol 77 (18) ◽  
pp. 1756
Author(s):  
Michael Biersmith ◽  
Thura Harfi ◽  
David Orsinelli ◽  
Scott Lilly ◽  
Konstantinos Boudoulas
Keyword(s):  
Mitral Valve ◽  
Kinetic Energy ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair

Characteristics and outcomes of patients with normal left atrial pressure undergoing transcatheter mitral valve repair

Heart ◽  
2020 ◽  
Vol 106 (12) ◽  
pp. 898-903 ◽  
Author(s):  
Jason R Sims ◽  
Guy S Reeder ◽  
Mayra Guerrero ◽  
Mohamad Alkhouli ◽  
Vuyisile T Nkomo ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
V Wave ◽  
Regurgitant Orifice Area

ObjectiveA subset of patients at the time of transcatheter mitral valve repair (TMVR) will have normal left atrial pressure (LAP) (<13 mm Hg) despite having severe mitral regurgitation (MR). The goal of this study was to determine clinical characteristics and outcomes in patients with normal LAP undergoing TMVR.MethodsA single-centre retrospective cohort of consecutive patients who underwent transcatheter edge-to-edge mitral valve clip and continuous LAP monitoring between 5/1/2014 and 5/1/2018 was analysed. One-year mortality was compared by Kaplan–Meier survival curves. Multivariable analysis was performed to identify predictors of normal LAP and 1 year mortality.ResultsOf the 204 patients undergoing TMVR, 65% were men and the mean age was 81. Of these patients, 31 (15%) had normal LAP (mean LAP 10.5 mm Hg, mean V wave 16.5 mm Hg) and 173 had elevated LAP (mean LAP 19 mm Hg, mean V wave 32.5 mm Hg). The prevalence of severe MR was not different between groups, although the normal LAP group had significantly lower effective regurgitant orifice area and regurgitant volume. Other notable baseline characteristics including prior cardiac surgery, atrial fibrillation, hypertension, diabetes, congestive heart failure, body mass index, mechanism of MR and ejection fraction were similar between groups. However, there was an increased prevalence of chronic lung disease (CLD) (45.2% vs 17.3%, p<0.001) in the normal LAP group. On multivariate analysis, the only significant predictor of normal LAP was the presence of CLD (OR 4.79 (1.83–12.36), p=0.001) and 1-year mortality was significantly higher in the normal LAP group (32.3% vs 12.7%, p=0.006). After adjustment for comorbidities, normal LAP was no longer a predictor of 1-year mortality (RR 1.62 (0.64–4.06), p=0.32); however, CLD (RR 3.44 (1.37–8.67), p=0.01) remained a statistically significant predictor.ConclusionNormal LAP at the time of TMVR is associated with a higher incidence of CLD which independently predicts increased 1-year mortality. In patients with CLD and apparently severe MR, measurement of LAP may help identify those with lower likelihood of benefit from TMVR.

P5574Prognostic impact of left atrial function following transcatheter mitral valve repair

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Ledwoch ◽  
C Fellner ◽  
F Poch ◽  
I Olbrich ◽  
R Thalmann ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Clinical Outcome ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
All Cause Mortality

Abstract Background Left atrial (LA) function predicts clinical outcome in a variety of cardiovascular diseases. However, limited data is available in the setting of mitral regurgitation (MR). Purpose The aim of the present study was to assess potential changes in LA ejection fraction (LA-EF) and its prognostic value in patients following transcatheter mitral valve repair using the mitraclip. Methods A total of 88 consecutive patients undergoing mitraclip implantation with complete echocardiography at baseline and follow-up between 3 and 6 months post-procedure were enrolled. Results LA-EF improved in 58% of the population. Change in LA-EF was associated with residual MR, residual transmitral gradient and left ventricular ejection fraction (LV-EF) changes. Compared to their counterparts, patients with residual MR ≥ grade 2 (−6% [−9 to 1%] vs. 4% [−5 to 15%]; p=0.05) and with residual transmitral gradient ≥5 mmHg (−2% [−9 to 9%] vs. 5% [−4 to 16%]; p=0.03) showed a decline in LA-EF, respectively. Furthermore, LA-EF significantly correlated with changes in LV-EF (r=0.40; p=0.001). With regards to clinical outcome, heart failure symptoms as assessed by NYHA class were more severe in patients with worsened LA-EF at follow-up. Finally, LA-EF change was identified as independent predictor of all-cause mortality (HR 0.94 [0.90–0.98]; p=0.008). Kaplan-Meier estimates for survival Conclusion The present analysis showed changes in LA function in patients undergoing mitraclip implantation to be associated with important measures including residual MR, elevated transmitral gradient and LV function. Importantly, LA function alterations represent a strong predictor for all-cause mortality.

Even a low transmitral pressure gradient after transcatheter mitral valve repair leads to impaired dynamic performance and increased left atrial endsystolic volumes

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Ziegler ◽  
M Rieger ◽  
G Gueder ◽  
S Frantz ◽  
P Nordbeck ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Atrial ◽  
Stress Echocardiography ◽  
Dynamic Stress ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Stress Echo

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Transcatheter mitral valve repair (TMVR) was shown to be safe and improves outcome in patients with severe functional mitral regurgitation (MR). Mean transmitral pressure gradients (MVG) &lt; 5.0 mmHg are generally tolerated after TMVR. However, the prognostic relevance of this arbitrary threshold remains unclear and dynamic changes during physical exercise are not well examined. METHODS From 2017 to 2019 48 patients with an indication for TMVR were prospectively enrolled in a single center study. The total physical capacity was measured by dynamic stress echocardiography on bicycle at baseline, before discharge and follow-up (FUP, mean (± SD) of 8.2 ± 1.4 months). Patients were classified into two groups: "MVG present" (MVG ≥ 2.5mmHg, measured by transesophageal echocardiography intraoperatively after TMVR) or "MVG absent". Between group differences were compared with a two-sided t-test. For association analysis the Pearson Product-Moment correlation coefficient was used. RESULTS 48 with a mean (± SD) age of 72.8 ± 12.1 years were eligible for the analysis. There was no significant difference in baseline characteristics concerning the level of the EuroScore II or prevalence of atrial fibrillation, heart failure, cardiovascular risk factors, renal failure or cardiomyopathy and demographic characteristics as age and sex, respectively. Also, most of the standard morphological and functional echocardiographic parameters as well as modern speckle-tracking derived parameters were similar between the 2 groups. There was no difference in remaining mitral regurgitation regarding severity between the two groups (p = 1.00). While the left atrial end systolic volumes (LAESV) at baseline did not differ significantly between groups, patients with an increased MVG after clipping showed an increase in LAESV (plus 56.2 ± 33.6 ml), while the other group showed a decrease in mean value (minus 15.9 ± 42.1 ml; baseline vs FUP: p &lt; 0.001). Further performance in dynamic stress echocardiography was significantly better in patients without development of a gradient (increase in metabolic equivalent of task (METS) changes between FUP and baseline 1.05 vs 0.06, p = 0.014). Most importantly, those patients who had a higher MVG after TMVR showed a significant increase in MVG already during stress-echo at baseline, compared to patients who didn´t develop a significant MVG after intervention (1.45 ± 1,08 mmHg vs. 0.67 ± 1,00 mmHg; p = 0.026). CONCLUSION After TMVR even a low MVG increase of &gt; = 2.5mmHg is associated with impaired performance in dynamic stress echo and with enlargement of LAESV. Increase of MVG in stress echo at baseline may be suitable to identify patients at risk to develop pathological MVG. Therefore, periprocedural caution to hemodynamic changes in MVG should always be given. Maybe a certain residual MR could be accepted before implanting an additional clip, knowing that already a MVG &gt; 2,5 mmHg might have adverse effects.

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