scholarly journals P1758 Global left ventricular myocardial work efficiency as a prognostic marker for clinical responders one year after edge-to-edge mitral valve repair in patients with functional mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Nyha Class ◽  
The Other ◽  
Work Efficiency ◽  
Valve Repair ◽  
Work Index ◽  
Class Status ◽  
Global Work ◽  
One Year

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) has been proven to be effective for treating patients with functional MR (FMR). However it remains to be answered which patients will benefit more from this method. Novel echocardiographic markers like myocardial work efficiency can be quantified non-invasively and have never been analyzed in this subgroup of patients before. Purpose The purpose of this study is to analyze the myocardial work efficiency in patients treated with PMVR for FMR and identify predictors of clinical response. Methods We retrospectively analyzed 22 high surgical risk (logistic EuroSCORE 28.9 ± 18.2%) consecutive patients (aged 72 ± 8yrs) with functional moderate-to-severe and severe mitral regurgitation (EROA 28.6 ± 14.6mm2, RV 41.7 ± 15.8ml) and reduced LV contractility (EF 32.7 ± 7.5%, GLS -8.8 ± 3.4%). At baseline and 1-year after PMVR or optimal medical treatment (OMT) we assessed echocardiographic parameters such as MR severity, Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE), along with BNP levels and NYHA class status. Results One year after PMVR there was a significant reduction of MR (3.6 ± 0.5 vs 1.8 ± 0.8, p = 0.009) and BNP levels (901 ± 610pg/ml vs 479 ± 385pg/ml, p < 0.001) and significant improvement of NYHA class status (3.0 ± 0.6 to 2.2 ± 0.4, p < 0.001). On the other hand, patients treated with OMT didn’t have any significant change of their MR (3.6 ± 0.5 vs 3.3 ± 1.0), BNP levels (296 ± 114 vs 241 ± 183pg/ml) or NYHA class status (2.6 ± 0.5 vs 2.4 ± 0.5). In device group, there was a preservation of GWI (572 ± 290 vs 609 ± 299mmHg%) and GCW (757 ± 310 vs 789 ± 316mmHg%) and non significant change of GWW and GWE (140 ± 70 vs 150 ± 73mmHg% and 79 ± 9 vs 79 ± 10% respectively, p < 0.05 for all comparisons). On the other hand in medical treatment group there was a significant impairment of GWI (635 ± 263 vs 564 ± 267mmHg%, p = 0.08) and GWE (83 ± 9 vs 76 ± 11%, p = 0.03) and significant increase of GWW (123 ± 90 vs 162 ± 74mmHg%, p < 0.001). Further, baseline GCW was reversely associated with the difference in BNP (r=-0.559, p = 0.038), NYHA class (r=-0.501, p = 0.06) and 6MWT (r=-0.577, p = 0.08) after PMVR, meaning that patients with worse energetics will respond better. Conclusions PMVR is an effective method for treating patients with FMR and preserves myocardial work index after one year of FU in contrast to medically treated patients in whom deterioration is observed.

P301Preserved global longitudinal strain predicts left ventricular reverse remodeling one year after edge-to-edge mitral valve repair in functional mitral regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Longitudinal Strain ◽  
Nyha Class ◽  
Walking Distance ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Post Intervention ◽  
Echocardiographic Parameters ◽  
One Year

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as an effective treatment modality for high surgical risk patients with severe functional mitral regurgitation (FMR). Novel echocardiographic parameters, such as deformation imaging and their predictive significance have not been analyzed in this group of patients. Purpose The purpose of this study is to identify echocardiographic predictors of response in patients with FMR undergoing PMVR. Methods We retrospectively analyzed 44 consecutive patients with ischemic or dilated cardiomyopathy, reduced ejection fraction and severe functional MR (FMR), aged 71±9 years, 71% males, LVEF 30.9±8.7%, mitral valve effective regurgitant orifice area (EROA)>20mm2, regurgitant volume (RV) >30ml and logistic EuroSCORE 22±14.7%. At baseline and 1-year after PMVR we assessed echocardiographic parameters such as LV longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS) using speckle tracking echocardiography, LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity by Doppler echocardiography along with BNP levels, NYHA class and 6 minute walking distance. Results One year after edge-to-edge repair there was a significant reduction of MR (74.2% had mild to moderate MR, 22.6% moderate-to-severe MR and 3.2% severe MR) and BNP levels (933±943pg/ml to 669±824pg/ml), improvement of NYHA class (3.11±0.55 to 2.0±0.6, P<0.05) and increase of the 6 minute walking distance (251±141 to 296±148m, P<0.05). LA volume was reduced (132.5±62.1ml to 115.2±57.7ml) and PALS was improved (6.89±3.47 to 7.94±5.27) (P<0.05 for all comparisons). Baseline LVGLS did not change significantly post intervention (−8.8±4.1 vs. −8.8±3.9, P=0.7) but the baseline value predicted the percentage difference in LVEDV (r=−0.61, P<0.01), LVESV (r=−0.47, P=0.03), BNP (r=0.45, P=0.04) and NYHA class (r=0.63, P<0.01). The best reverse LV remodeling was found in patients with GLS better than −10% and the trend was that the better the GLS the greater the LVEDV and LVESV reduction post-intervention. Additionally, patients with GLS between −10% and −5% had the largest improvement in BNP (P<0.05) and NYHA class (P=0.005). Conclusions Edge-to-edge repair is effective in reducing MR in patients with severe functional MR and has a positive impact in patients' clinical status at one year follow up. A preserved LVGLS seems to be a good predictor of reverse modeling and clinical improvement post intervention.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

scholarly journals Edge-to-edge transcatheter valve repair of atrial functional mitral regurgitation positively influences atrial pathology

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Petrescu ◽  
M Geyer ◽  
T Ruf ◽  
O Hahad ◽  
A Tamm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Nyha Class ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Transcatheter Mitral Valve Repair ◽  
Mean Pressure

Abstract Introduction Functional mitral regurgitation (FMR) is the result of an insufficient coaptation of the mitral valve leaflets lacking relevant degeneration or morphological alterations of the valve apparatus. In most patients, this is caused by left ventricular (LV) systolic dysfunction and remodelling (ischemic or non-ischemic). However, a small subset of FMR patients is seen in the context of left atrial (LA) enlargement due to isolated atrial dilation in the absence of a ventricular pathology and has been termed “atrial functional MR” (AFMR) as a distinct etiology of FMR. The effect of transcatheter mitral valve repair (TMVR) by edge-to-edge-repair (e.g., MitraClip®) on AFMR reduction has not been studied, but it is considered to be effective regarding its effect on the anterior-posterior mitral annular diameter. Methods We retrospectively screened all 737 patients treated with TMVR by edge-to-edge repair in our center between January 2013 and April 2019. AFMR was defined as FMR with: (1) relevant LA dilatation, (2) no LV systolic dysfunction or (3) dilatation, (4) no ischemic etiology of FMR. LA mean pressure was invasively measured peri-interventionally before and after device implantation. Echocardiographic assessment was repeated at 1 year follow-up (1yFUP). Results Among 350 patients (47.5%) with FMR, 57 patients (16.3%) met the inclusion criteria for AFMR and were included in the data analysis. All patients in the AFMR group (mean age 81.4±5.7 years, 78.9% female) were symptomatic (82.2% functional NYHA class≥III) at baseline and were assessed to be at elevated risk for surgery (mean logistic EuroScore of 24.8±12.0%). TVMR was successfully performed in all patients without any peri-interventional major complications. At hospital discharge, 78.3% of patients had mild residual MR and 17.4% had no detectable MR. At 1 year, the echocardiographic prevalence of residual moderate MR was 11.4% and 2.9% of patients had severe MR (Figure A). Invasive LA mean pressure measurements were available in 39 patients (68.4%). In average, LA mean pressures decreased from 18.8 mmHg to 12.8 mmHg (p&lt;0.001). Analysis at 1yFUP showed a significant reduction in LA volume, both at end-systole (79.6±31.9 vs. 66.9±31.8 ml/m2 p&lt;0.001; Figure B) and at end-diastole (61.6±21.5 vs. 50.4±27.37 ml/m2; p&lt;0.01; Figure C). LA ejection fraction increased from 18.8%±12.6% to 30.1%±12.3% in 54.8% of patients. These findings were accompanied by a relevant symptomatic benefit (NYHA class I/II was found in 66.7% of patients at 1 year). Conclusions Transcatheter mitral valve repair by edge-to-edge therapy in symptomatic patients with atrial functional mitral regurgitation is safe and capable of a relevant reduction of mitral regurgitation severity accompanied by symptomatic improvement and positive atrial remodeling. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predictors of functional mitral regurgitation recurrence after percutaneous mitral valve repair

2021 ◽  
Author(s):  
Katharina Hellhammer ◽  
Jean M. Haurand ◽  
Maximilian Spieker ◽  
Peter Luedike ◽  
Tienush Rassaf ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Atrium ◽  
Left Ventricular ◽  
Functional Class ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
Percutaneous Mitral Valve Repair ◽  
Sphericity Index ◽  
One Year

AbstractWe aimed to identify predictors of mitral regurgitation recurrence (MR) after percutaneous mitral valve repair (PMVR) in patients with functional mitral regurgitation (FMR). Patients with FMR were enrolled who underwent PMVR using the MitraClip® device. Procedural success was defined as reduction of MR of at least one grade to MR grade ≤ 2 + assessed at discharge. Recurrence of MR was defined as MR grade 3 + or worse at one year after initially successful PMVR. A total of 306 patients with FMR underwent PMVR procedure. In 279 out of 306 patients (91.2%), PMVR was successfully performed with MR grade ≤ 2 + at discharge. In 11.4% of these patients, MR recurrence of initial successful PMVR after 1 year was observed. Recurrence of MR was associated with a higher rate of heart failure rehospitalization during the 12 months follow-up (52.0% vs. 30.3%; p = 0.029), and less improvement in New York Heart Association (NYHA) functional class [68% vs. 19% of the patients presenting with NYHA functional class III or IV one year after PMVR when compared to patients without recurrence (p = 0.001)]. Patients with MR recurrence were characterized by a higher left ventricular sphericity index {0.69 [Interquartile range (IQR) 0.64, 0.74] vs. 0.65 (IQR 0.58, 0.70), p = 0.003}, a larger left atrium volume [118 (IQR 96, 143) ml vs. 102 (IQR 84, 123) ml, p = 0.019], a larger tenting height 10 (IQR 9, 13) mm vs. 8 (IQR 7, 11) mm (p = 0.047), and a larger mitral valve annulus [41 (IQR 38, 43) mm vs. 39 (IQR 36, 40) mm, p = 0.015] when compared to patients with durable optimal long-term results. In a multivariate regression model, the left ventricular sphericity index [Odds Ratio (OR) 1.120, 95% Confidence Interval (CI) 1.039–1.413, p = 0.003)], tenting height (OR 1.207, 95% CI 1.031–1.413, p = 0.019), and left atrium enlargement (OR 1.018, 95% CI 1.000–1.038, p = 0.047) were predictors for MR recurrence after 1 year. In patients with FMR, baseline parameters of advanced heart failure such as spherical ventricle, tenting height and a large left atrium might indicate risk of recurrent MR one year after PMVR.

Global Constructive Work predicts left ventricular reverse remodeling one year after MitraClip implantation in patients with functional mitral regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Papadopoulos ◽  
I Ikonomidis ◽  
M Chrissoheris ◽  
A Chalapas ◽  
P Kourkoveli ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Left Ventricular Reverse Remodeling ◽  
Work Index ◽  
Constructive Work ◽  
Global Work ◽  
One Year

Abstract Background Percutaneous edge-to-edge mitral valve repair (PMVr) has recently been identified as an effective method for treating patients with functional mitral regurgitation. However, it is still unknown which patients will benefit by showing clinical improvement and left ventricular reverse remodeling. Purpose The purpose of this study is to analyze novel echocardiographic markers and identify markers of LV reverse remodeling after MitraClip implantation. Methods We retrospectively analyzed 58 high surgical risk (logistic EuroSCORE 23±15%) consecutive patients (aged 72±10yrs) with functional moderate-to-severe and severe mitral regurgitation (EROA 29±14mm2) and reduced LV contractility (EF 32±8%, GLS −8.6±3.7%). At baseline and 1-year after PMVr we assessed echocardiographic parameters such as MR severity, EF, Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE). Results In patients with MitraClip implantation there was a significant reduction of MR (3.7±0.4 vs 1.7±0.8, p&lt;0.001) one year after the intervention. The EF and GLS did not improve after the implantation (32±8 vs 33±10%, p=0.178 & −8.6±3.7 vs −8.6±3.7%, p=0.922 respectively) but Global Work Index (GWI) and Global Constructive Work (GCW) demonstrated significant improvement (607±282 vs 650±260mmHg%, p=0.04 & 854±288 vs 949±325mmHg%, p&lt;0.001 respectively). The baseline EF, GLS, GWI, GCW and EROA were the factors that were significantly associated with more than 20% reduction of LVEDV one year after intervention (p&lt;0.02 for all). To be more specific, left ventricles with better performance and contractility combined with worse mitral regurgitation were the ones that responded better. Further, baseline GCW was the only factor that was significantly associated with reduction of the LVESV. A ROC curve analysis identified a cut-off value of 846mmHg% (AUC 0.759, 95% CI: 0.588–0.930; p=0.007) to be associated with 10% reduction of LVESV, with a sensitivity and specificity of 79% and 74% respectively. Conclusions Transcatheter edge-to-edge repair is an effective method for treating patients with FMR and improves LV performance one year after intervention. A preserved baseline GCW seems to be a good predictor of LV reverse remodeling after MitraClip implantation. Funding Acknowledgement Type of funding source: None

Six-month and one-year outcomes with the PASCAL transcatheter valve repair system for patients with mitral regurgitation from the multicentre, prospective CLASP study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Spargias ◽  
M Szerlip ◽  
S Kar ◽  
R Makkar ◽  
R Kipperman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Nyha Class ◽  
Severe Bleeding ◽  
Funding Source ◽  
Repair System ◽  
Valve Repair ◽  
Clinically Significant ◽  
Transcatheter Valve ◽  
One Year ◽  
Paired Analysis

Abstract Background Transcatheter mitral valve repair has emerged as a viable option for treating mitral regurgitation (MR). We report results from the multicentre, prospective, single arm CLASP study with the PASCAL transcatheter valve repair system. Methods 109 patients with clinically significant MR deemed candidates for transcatheter repair by the local heart team were treated in the CLASP study. The study evaluated safety, performance, clinical and echocardiographic outcomes and included an independent clinical events committee and echocardiographic core lab. The primary safety endpoint was a composite MAE rate at 30 days of cardiovascular mortality, stroke, MI, new need for renal replacement therapy, severe bleeding, and re-intervention for study device-related complications. Results Mean age was 76 years, 54% male, 57% NYHA Class III/IV, 100% MR grade ≥3+ with 62% functional, 31% degenerative, 7% mixed etiology. Successful implantation was achieved in 95% of patients. At 30 days, the MAE rate was 8.3% including one cardiovascular mortality due to cardiogenic shock as a result of severe bleeding at the contralateral arterial access site for hemodynamic monitoring further complicated by disseminated intravascular coagulation, one stroke, and one conversion to mitral valve replacement surgery. In paired analysis, 88% of patients were in NYHA Class I/II (p&lt;0.001), MR grade was ≤1+ in 79% of patients and ≤2+ in 96% of patients. Significant improvements in 6MWD (+27 m, p&lt;0.001) and KCCQ (+16 points, p&lt;0.001) were observed. The six-month data will be available for presentation. In addition, we report one-year follow up of the first 62 patients (ITT): 93% one-year survival rate (Kaplan-Meier estimate), no stroke, no late reintervention, one late MI. In paired analysis, MR grade was ≤1+ in 82% of patients and ≤2+ in 100% of patients. 88% of patients were in NYHA Class I/II (p&lt;0.001), 6MWD improved by 21 m (p=0.124) and KCCQ improved by 13 points (p&lt;0.001). Conclusions This study demonstrates the PASCAL transcatheter valve repair system is safe and resulted in robust MR reduction with 100% of patients achieving MR ≤2+, and ∼ 80% MR ≤1+, sustained at one year. Results show high survival and low complication rates, and sustained improvements in functional status, exercise capacity, and quality of life at one year in patients with clinically significant, symptomatic MR. The CLASP IID/IIF pivotal trial is underway. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Edwards Lifesciences (Irvine, CA)

scholarly journals Clinical and haemodynamic effects of percutaneous edge-to-edge mitral valve repair in atrial versus ventricular functional mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M J Claeys ◽  
P Debonnaire ◽  
V Bracke ◽  
G Bilotta ◽  
N Shkarpa ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Functional Status ◽  
Mitral Valve Repair ◽  
Nyha Class ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Atrial Remodeling ◽  
Systolic Pulmonary Artery Pressure ◽  
Valve Repair

Abstract Background Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function. Purpose To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR. Methods MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention. Results MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization. Conclusion Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts. FUNDunding Acknowledgement Type of funding sources: None. MACE in A-FMR versus V-FMR pts

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