scholarly journals Correlation of intraprocedural and follow up parameters for mitral regurgitation grading after percutaneous edge-to-edge repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Salinas Gallegos ◽  
E Pozo Osinalde ◽  
X Gordillo ◽  
P Jimenez Quevedo ◽  
P Marcos-Alberca ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
University Hospital ◽  
Vena Contracta ◽  
Funding Sources ◽  
Mitral Repair ◽  
Risk Patients

Abstract Background Percutaneous edge-to-edge mitral repair has merged as an effective therapy for moderate-to-severe mitral regurgitation (MR) in high surgical risk patients. Transesophageal echocardiogram (TEE) is crucial for procedure guiding and immediate result evaluation, whereas transthoracic echocardiogram (TTE) is largely used in follow up. However, there is no consensus on the best intraprocedural parameter to evaluate residual MR. Purpose To evaluate the predictive value of different MR parameters from intraprocedural TEE with grading in consecutive TTE during the follow up. Methods All the consecutive patients who underwent percutaneous mitral repair with the MitraClip system between 2010 and 2020 in our tertiary university hospital were considered for this study. Immediate posprocedural MR parameters (number of jets, summatory and maximum vena contracta (VC), summatory and maximum 3D effective regurgitation orifice (ERO) and pulmonary vein (PV) flow parameters) were reassessed when possible blindly to the follow up MR grading in sequential TTE. Results We included 88 patients (64.8% males) with a mean age of 76±10 years. Baseline MR was graded as moderate-to-severe in 13 (14.8%) and severe in 75 (85.2%). The most frequent MR etiology was secondary (44.3%) followed by primary (35.2%) and mixed (20.5%). Patients presented with mild left ventricular systolic dysfunction (LVEF 44.5±15.3%) and dilatation (LVEDVi 71.8 [51.5–102.8] mL/m2). MR grading distribution remained stable at 1 and 6 months follow up TTE. Among all the aforementioned criteria only summatory and maximum VC remained significant for different MR grade prediction. Thus, these values were able to identify MR ≥3 at 1 and 6 months (Table). Moreover, on ROC analysis maximum VC demonstrated an excellent discriminatory power to identify significant MR at 6 months (Figure). Thereby, a cut-off point of 0.45 cm was able to predict MR ≥3 with 88% sensitivity and 89% specificity. Conclusion Among intraprocedural TEE parameters to evaluate residual MR in percutaneous edge-to-edge mitral repair, maximum and summatory VC appeared to be the more reliable to predict significant insufficiency in the follow up. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Differences in intraprocedural TEE VC in relation with significant MR in follow-up TTE Figure 1. ROC curve of maximum VC for prediction of significant MR at 6 months

Abstract 17145: Mitral Leaflet Growth and its Relationship with Functional Mitral Regurgitation in Non-ischemic Left Ventricular Systolic Dysfunction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yu Kang ◽  
Xiao-Jing Chen ◽  
Qing Zhang ◽  
Xiao-Ling Sun ◽  
Yu-Chen Chen ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Area Ratio ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Significant Difference ◽  
Annular Dilation

Backgrounds: Recent studies evidenced growth of the mitral leaflet (ML) in patients with functional mitral regurgitation (FMR), casting doubt on the traditional understanding of FMR. The aim of this study was to explore whether growth of ML occurs in patients with non-ischemic left ventricular (LV) systolic dysfunction and to examine whether there was any relationship between the growth of ML and the development of FMR. Methods: Echocardiographic examination was performed in 3 groups of patients: patients with non-ischemic LV systolic dysfunction [LV ejection fraction (EF) <50%] and significant FMR (MR jet area ratio≥20%) (group1, n=40), patients with non-ischemic LV systolic dysfunction but no significant FMR (MR jet area ratio <20%) (group2, n=30), and normal subjects (group3, n=40). The lengths of the anterior (AML) and posterior (PML) mitral leaflets as well as the anterior-posterior mitral annular dimension (MAD) were measured to reflect the degree of ML growth and mitral annular dilation. The ratio of AML and PML to MAD (AML: MAD, PML: MAD) were calculated respectively to assess the adequacy of ML growth in the context of mitral annular dilation. Results: The AML, PML, and the MAD were all increased in patients with LV systolic dysfunction (group1 and group2) compared with normal subjects (group3). In patients with LV systolic dysfunction, both PML and MAD were further increased in group1 compared with group2. However, AML showed no significant difference between the 2 groups. As a result, PML:MAD showed no significant difference between group1 and group2, while AML:MAD was significantly decreased in group1 compared with group2 (Table 1). Conclusion: Mitral leaflet growth occurs in patients with non-ischemic LV systolic dysfunction. Insufficient growth of the anterior mitral leaflet relative to dilated mitral annulus is associated with the development of significant FMR.

P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Thomsen ◽  
S Pedersen ◽  
P K Jacobsen ◽  
H V Huikuri ◽  
P E Bloch Thomsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Loop Recorder ◽  
Ventricular Ejection Fraction ◽  
New Onset

Abstract Introduction The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres. Purpose The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias. Methods The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization. Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis. Results A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted). Figure 1 Conclusion(s) The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.

scholarly journals Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

2020 ◽  
Vol 21 (3) ◽  
pp. 807 ◽  
Author(s):  
Iwona Świątkiewicz ◽  
Przemysław Magielski ◽  
Jacek Kubica ◽  
Adena Zadourian ◽  
Anthony N. DeMaria ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Multivariable Analysis ◽  
High Sensitivity ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Reactive Protein

Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP24), discharge (CRPDC), and 1 month after discharge (CRP1M). LVSD at 6 months after discharge (LVSD6M) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD6M occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD6M vs. 4.9% without LVSD6M (p < 0.0001). Compared to patients without LVSD6M, the patients with LVSD6M had higher CRP24 and CRPDC and persistent CRP1M ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP24 ≥ 19.67 mg/L improved the prediction of LVSD6M with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD6M who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.

scholarly journals Diabetic cardiomyopathy: acute and reversible left ventricular systolic dysfunction due to cardiotoxicity of hyperglycaemic hyperosmolar state—a case report†

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Umut Kocabaş ◽  
Özgür Yılmaz ◽  
Volkan Kurtoğlu
Keyword(s):  
Blood Glucose ◽  
Diabetic Cardiomyopathy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Blood Glucose Control ◽  
Left Ventricular ◽  
Pathophysiological Mechanism ◽  
Ventricular Systolic Dysfunction ◽  
Arterial Blood

Abstract Background Diabetic cardiomyopathy (DC) is defined as a ventricular diastolic and/or systolic dysfunction, which is directly related to diabetes mellitus (DM) in the absence of coronary artery disease, valvular, congenital or hypertensive heart disease, and alcoholism. In this report, we present an unusual case of a patient with DC and reversible, acute left ventricular systolic dysfunction due to cardiotoxicity of hyperosmolar hyperglycaemic state (HHS). Case summary A 20-year-old male patient presented with weakness and polyuria. Physical examination and electrocardiogram were normal. Laboratory results and arterial blood gas analysis were consistent with HHS. Baseline echocardiography showed global left ventricular hypokinesis with an ejection fraction (EF) of 36%. The patient’s clinical condition improved after blood glucose level normalization and echocardiography revealed progressive improvement in the left ventricular systolic function with an EF of 54% at the 5-day follow-up and an EF of 69% at the 15-day follow-up. Discussion Uncontrolled DM and hyperglycaemic crisis may result in cardiotoxicity, acute left ventricular systolic dysfunction, and DC. The pathophysiological mechanism of this phenomenon is still unclear. Blood glucose control is the most important strategy for the prevention of DC.

scholarly journals Cardiac resynchronization therapy following Carillon® annuloplasty device for symptomatic heart failure and functional mitral regurgitation: a case report

2019 ◽  
Vol 3 (4) ◽  
pp. 1-5
Author(s):  
Haqeel A Jamil ◽  
Steven L Goldberg ◽  
Klaus K Witte
Keyword(s):  
Mitral Regurgitation ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Functional Mitral Regurgitation ◽  
Symptom Improvement ◽  
Resynchronization Therapy ◽  
Bundle Branch Block

Abstract Background  Symptomatic patients with significant left ventricular systolic dysfunction (LVSD) require a tailored treatment approach. Both functional mitral regurgitation (FMR) and left bundle branch block (LBBB) can develop, contributing to clinical deterioration, and worse prognosis despite optimal medical therapy (OMT). Case summary  We report the case of a symptomatic 60-year-old man on OMT with LVSD and significant FMR. His symptoms and FMR initially improved following transvenous mitral annuloplasty using the Carillon® Mitral Contour System® annuloplasty device. However, he subsequently developed LBBB with associated reduction in exercise capacity, for which he underwent cardiac resynchronization therapy, and ensuing symptom improvement and stabilization. Discussion  Our case describes how targeted device interventions can be combined synergistically to optimize patient symptoms.

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