Functional Mitral Regurgitation in Heart Failure: Analysis of the ESC Multidisciplinary Heart-Team Position Statement and Review of Current Guidelines

2021 ◽  
Author(s):  
Daniel S. Cormican ◽  
Zachary Drennen ◽  
Abraham Sonny ◽  
Jerome C. Crowley ◽  
Iván J. Núñez Gil ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Failure Analysis ◽  
Position Statement ◽  
Functional Mitral Regurgitation ◽  
Heart Team ◽  
Current Guidelines

scholarly journals 425 Alterations in left atrial structure and function in chronic heart failure patients with functional mitral regurgitation after MitraClip

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Ozturk ◽  
T Fasell ◽  
J M Sinning ◽  
N Werner ◽  
G Nickenig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Mitral Regurgitation ◽  
Stroke Volume ◽  
Left Atrial ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Heart Team ◽  
Heart Failure Patients ◽  
And Function

Abstract Backround The MitraClip procedure has been increasingly performed as an established treatment alternative for symptomatic patients with moderate to severe mitral regurgitation (MR) at prohibitive surgical risk. Left ventricular (LV) reverse remodelling following MitraClip has been shown in different studies. Left atrial (LA) volumes are believed to decrease following interventional reduction of MR. However, effects of MitraClip on LA function are not well understood. Objectives In this study we aimed to evaluate the effect of MitraClip on LA structure, volumes and function in chronic heart failure patients with functional MR. Methods All patients underwent 3D transthoracic echocardiography prior to the MitraClip procedure and at follow-up (FU) with offline evaluation of LA function and geometry using dedicated software (TomTec Image Arena, 4D LV-Analysis, Munich, Germany). FU examinations were performed 10 ± 3.4 months after the procedure. Results We prospectively included 75 consecutive surgical high risk (Logistic EuroScore: 17.2 ± 13.9%) patients (Age: 77 ± 9years, 22% female) with symptomatic moderate to severe MR without atrial fibrillation. All patients underwent MitraClip following heart team decision without periinterventional major complications. Baseline echocardiography showed impaired left ventricular function (Ejection fraction (EF): 32,6 ± 11.2%), moderate to severe MR , increased systolic right ventricle pressure (RVSP: 46.1 ± 10.5 mmHg) and elevation in estimated left ventricle enddiastolic pressure (E/E´ ratio: 15.6 ± 7.3) in the patient cohort. There was no relevant mitral stenosis after the procedure (MPG: 3.3 ± 0.5 mmHg), however the MPG increased significantly after the procedure (p = 0.05). The E/E´ ratio significantly increased at FU (15.6 ± 7.3, 24.1 ± 13.2, p = 0.05) as well. The left atrial (LA) volumes and LA-muscular mass (End-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) significantly increased at FU (LA-EDV: 83.1 ± 39.5ml, 115.1 ± 55.3ml, p = 0.012; LA-ESV: 58.4 ± 33.4ml, 80.1 ± 43.9ml, p = 0.031; 105.1 ± 49.3gr, 145.4 ± 70.6gr, p = 0.013). LA stroke volume significantly increased after the procedure (24.6 ± 12.5ml, 34.9 ± 19.1ml, p = 0.016). LA-EF and atrial global longitudinal strain (LA-GLS) showed no significant changes at FU (LA-EF: 31.7 ± 12.8%, 31.1 ± 12.3%, p= 0.8; LA-GLS: -10.8 ± 5.4%, -9.7 ± 4.45%, p = 0.4). Despite no relevant changes during FU, baseline E/E´ ratio (AUC: 0.652) and baseline aGLS (AUC: 0.694) were found to be independent predictors for mortality. Conclusion Transcatheter MV repair (TMVR) with the MitraClip procedure improves atrial stroke volume, increases atrial volumes and muscular mass acutely after the procedure. It might be explained by the acutely increased MPG and LVEDP after the MitraClip procedure. Baseline aGLS and E/E´ ratio were found to be independent predictors for mortality.

The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

2020 ◽  
Vol 75 (5) ◽  
pp. 514-522
Author(s):  
Alexey S. Ryazanov ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Effective Area ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Angiotensin Receptor ◽  
Optimal Drug ◽  
Patients With Heart Failure ◽  
Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

2020 ◽  
Vol 21 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Tomás Benito-González ◽  
Rodrigo Estévez-Loureiro ◽  
Pedro A. Villablanca ◽  
Patrizio Armeni ◽  
Ignacio Iglesias-Gárriz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Medical Therapy ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair

Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Greta Generati ◽  
Francesco Bandera ◽  
Marta Pellegrino ◽  
Valentina Labate ◽  
Eleonora Alfonzetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Functional Mitral Regurgitation ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Pulmonary Hemodynamic ◽  
Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

Redistribution of cardiac output during exercise by functional mitral regurgitation in heart failure: compensatory O2 peripheral uptake to delivery failure

2020 ◽  
Vol 319 (1) ◽  
pp. H100-H108
Author(s):  
Marco Guazzi ◽  
Greta Generati ◽  
Barry Borlaug ◽  
Eleonora Alfonzetti ◽  
Tadafumi Sugimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Gas Exchange ◽  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Functional Evaluation ◽  
Severe Mitral Regurgitation ◽  
Reduced Ejection Fraction ◽  
Heart Failure Patients ◽  
Fraction Versus

This is an analysis involving 134 heart failure patients with reduced ejection fraction versus 80 controls investigated during functional evaluation with gas exchange and hemodynamic, addressing the severe mitral regurgitation phenotype and testing the hypothesis that the backward cardiac output redistribution to the lung during exercise impairs delivery and overexpresses peripheral extraction. This information is new and has important implications in the management of heart failure.

scholarly journals MitraClip in patients with functional mitral regurgitation and advanced heart failure - Single centre experience

Cor et Vasa ◽  
2019 ◽  
Vol 61 (1) ◽  
pp. 8-14
Author(s):  
Aleš Benák ◽  
Blanka Skalická ◽  
Jana Hašková ◽  
Martin Kotrč ◽  
Radka Kočková ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Advanced Heart Failure ◽  
Functional Mitral Regurgitation ◽  
Single Centre ◽  
Single Centre Experience

scholarly journals Analysis of Risk Factors for Acute Heart Failure in Patients with Dilated Cardiomyopathy and Persistent Severe Functional Mitral Regurgitation Despite Cardiac Resynchronization Therapy

2020 ◽  
pp. 35-39
Author(s):  
R. V. Buriak ◽  
K. V. Rudenko ◽  
O. A. Krykunov
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Resynchronization Therapy

Congestive heart failure resulting from non-ischemic dilated cardiomyopathy (DCM) with secondary functional mitral regurgitation (FMR) is associated with poor prognosis. Medical treatment results in a 1-year survival of 52% to 87% and a 5-year survival of 22% to 54%, with highest survivals observed in more recent years, probably reflecting improvements in medical therapy. Non-surgical interventions involve cardiac resynchronization therapy. In addition to medical treatment, cardiac resynchronization therapy (CRT) should be considered in patients with New York Heart Association (NYHA) class II– IV HF, left ventricular ejection fraction (LVEF) =35%, normal sinus rhythm and left bundle branch block with QRS >150 ms. In these patients, CRT can also facilitate left ventricular (LV) reverse remodeling and reduce associated FMR. The aim of this study was to investigate the features of symptomatology and to analyze the risk factors for acute heart failure (AHF) in patients with DCM and persistent severe functional mitral regurgitation despite CRT and optimal guideline-directed medical therapy (GDMT). Materials and methods. After providing informed consent, 144 patients with severe FMR were involved in the study. Concomitant tricuspid valve regurgitation was registered in 142 (98.6%) cases. The median LVEF was 27.0 (23.0-31.6)%. 40 (27.8%) patients had a permanent form of atrial fibrillation, and 24 (16.7%) patients had a first-degree atrioventricular node block. The median NT-proBNP was 2600 (2133-3200) pg/ml, indicating the presence of severe chronic heart failure. Results. The median term after CRT device implantation was 36 (3.5-60) months. A comparative analysis between DCM patients with and without CRT revealed statistically significant differences between clinical characteristics, namely: age (p=0.020), lower heart rate (p=0.004), lower hemoglobin (p=0.017), higher erythrocyte sedimentation rate (ESR) (p=0.000) and more frequent AHF at the hospital stage (p=0.030). The incidence of AHF at the hospital stage was 13.8% in patients with CRT and 3.5% in those without CRT. The calculated odds ratio of AHF was 4.44 (95% confidence interval (CI) 1.039-18.971), and the relative risk of AHF was 3.966 (95% CI 1.054-14.915). Discussion. FMR has been reported to persist in about 20% to 25% of CRT patients and, in an additional 10% to 15%, it may actually worsen after CRT. In this subset of CRT non-responders, reduced reverse remodeling, increased morbidity, and increased mortality have been reported compared with CRT patients in whom FMR was significantly reduced or abolished. Conclusions. The results of our study demonstrate that severe functional mitral regurgitation despite cardiac resynchronization therapy in patients with dilated cardiomyopathy is a significant risk factor for AHF and subsequent hospitalizations for heart failure.

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