scholarly journals Prognostic value of three dimensional-vena contracta area in patients with secondary mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Yedidya ◽  
V Mantegazza ◽  
F Namazi ◽  
R Lustosa ◽  
S C Butcher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Color Doppler ◽  
Three Dimensional ◽  
Heart Failure Hospitalization ◽  
Vena Contracta ◽  
All Cause Mortality ◽  
3D Color Doppler ◽  
Vena Contracta Area

Abstract Background Effective regurgitant orifice area (EROA) is an important quantitative measurement for mitral regurgitation (MR) grading. Yet, the accuracy of this method is limited in patients with secondary mitral regurgitation (SMR). Three-dimensional (3D) color Doppler echocardiography allows for the direct assessment of the vena contracta area (VCA). The prognostic value of 3D-VCA in patients with secondary MR has not been investigated. Purpose The aim of the present study was to assess the association between 3D-VCA and prognosis of patients with SMR. Methods A total of 218 patients (69% men, median age 74 years) with significant SMR were retrospectively analyzed. 3D-VCA was measured offline with dedicated software, from restored 3D color Doppler full volume datasets of the mitral valve (Figure 1). The population was divided according to the American College of Cardiology expert recommendation for the grading of severe MR (VCA ≥50 mm2 and VCA <50 mm2). Patients were followed up for the combined end point of all-cause mortality or heart failure hospitalization. Results Of the total population, 63% had an ischemic etiology, 60% had atrial fibrillation and 25% cardiac resynchronization therapy. Patients with 3D-VCA ≥50 mm2 needed more diuretic therapy, had a larger left ventricle and atrium, and had more post-procedural residual MR. A total of 82% of patients underwent MitraClip device implantation, 17% had mitral valve repair and 1% had mitral valve replacement. During a median follow-up of 28 months, 130 (60%) met the combined end point (101 (46%) patients died and 81 (37%) were hospitalized due to heart failure). When dividing the population according to the cut-off of 3D-VCA, patients with a 3D-VCA≥50 mm2 had a worse prognosis compared with their counterparts (Figure 2). In a multivariable Cox regression analysis, 3D-VCA≥50 mm2 remained independently associated with the composite endpoint of all-cause mortality or heart failure hospitalization (HR=1.454, 95% CI 1.020–2.072, p=0.038). Conclusion In patients with SMR, a 3D-VCA ≥50 mm2 was independently associated with a combined endpoint of death or heart failure hospitalization. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Method of 3D-VCA measurement Figure 2. Kaplan-Meier survival curve

Abstract 3382: Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Mitral Regurgitation Vena Contracta Area: A Clinical Experience

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stephen H Little ◽  
Rahul Kumar ◽  
Bahar Pirat ◽  
Marti L McCulloch ◽  
William A Zoghbi
Keyword(s):  
Mitral Regurgitation ◽  
Stroke Volume ◽  
Real Time ◽  
Direct Measurement ◽  
Color Doppler ◽  
Three Dimensional ◽  
Vena Contracta ◽  
Doppler Study ◽  
3D Color Doppler ◽  
Valve Pathology

Introduction: 3D color Doppler allows a direct measurement of Vena Contracta (VC) area in patients with mitral regurgitation (MR), without the need for geometric assumptions. Hypothesis: 3D color Doppler VC area provides a more accurate assessment of MR severity than the conventional 2D color Doppler VC diameter. Methods: Patients with ≥ mild MR underwent 2D and 3D color Doppler and a quantitative echo-Doppler study. 2D VC diameter was measured from a zoomed parasternal long-axis view. 3D VC area was acquired using real-time 3D (Philips) and measured off-line (TomTec). MR severity was assessed both quantitatively, as effective regurgitant orifice area from pulsed Doppler [EROA = (mitral stroke volume - aortic stroke volume)/MR time velocity integral], and semi-quantitatively as recommended by the American Society of Echocardiography. Results: 61 patients (65 ± 15 years) were studied. MR severity was mild in 25%, moderate in 36%, and moderate to severe or severe in 39%. Mitral valve pathology was prolapse in 33%, restricted closure in 44% and annular calcification in 7%. Regurgitant MR jet was eccentric in 49% of patients. For all patients, 3D VC area correlated significantly with EROA, better than 2D VC diameter (figure ). The advantage of 3D VC area over 2D VC diameter was more pronounced in eccentric jets (r=0.76, p< 0.001 vs. r=0.5, p =0.006, respectively) and in moderate to severe or severe MR (r=0.65, p<0.001 vs. r =0.13, p=0.54, respectively). Conclusions : Measurement of VC area is feasible with real-time 3D and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.

scholarly journals The Most Accurate and Fastest Method for Measurement of Vena Contracta Area by Direct Planimetry 3D Transesophageal Echocardiography

2018 ◽  
Vol 6 (3) ◽  
pp. 29
Author(s):  
Mehrnoush Toufan ◽  
Dina Ashouri
Keyword(s):  
Clinical Practice ◽  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Two Dimensional ◽  
Vena Contracta ◽  
2D Echocardiography ◽  
3D Transesophageal Echocardiography ◽  
Integrative Method ◽  
Vena Contracta Area ◽  
Reliable Methods

Dear Editor, Two-dimensional (2D) echocardiography is a powerful tool for assessment of mitral regurgitation (MR) [1]. However, it bears several major disadvantages. Evidence suggests that measurement of the vena contracta area (VCA) via a three-dimensional (3D) method is significantly more accurate than 2D methods in the quantification of MR since the 2D method is not sufficiently reliable in calculation of VC diameter because of  circular assumption of VC area [2]. VCA direct planimetry (DP) and multiplanar reconstruction (MPR)-derived VCA are direct and reliable methods to quantify MR severity, and their results are comparable with those of 2D integrative method [2, 3]. It is strongly recommended that these methods especially DP can replace 2D methods in the quantification of MR in the clinical practice, as it is more accurate and easy to perform [3].

P4725Prognostic relevance of the COAPT inclusion criteria in real-world patients with secondary mitral regurgitation undergoing mitraclip implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Iliadis ◽  
C Metze ◽  
M I Koerber ◽  
S Baldus ◽  
R Pfister
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Real World ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Inclusion Criteria ◽  
Heart Failure Hospitalization

Abstract Background The recently published Cardiovascular Outcomes Assessment of the mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) randomized trial has shown a huge benefit in the survival of patients with systolic heart failure and functional mitral regurgitation treated with MitraClip. However, patients in COAPT were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear. Methods Our study examined the clinical outcome in consecutive patients from our Heart Centre with reduced left-ventricular ejection fraction (EF<50%) undergoing mitraclip for mitral regurgitation of dominant functional etiology by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction >20%, left ventricular end-systolic dimension <70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure <70 mmHg, mitral valve orifice area >4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). The composite endpoint of all-cause mortality or heart failure hospitalization and the endpoint of heart failure hospitalization were analysed. Results Among 123 patients who underwent mitraclip implantation 60.2% fulfilled the inclusion criteria of COAPT. Overall, 54 patients (46.6%) died or were hospitalized for heart failure during a median follow-up time of 19 months. The composite endpoint was significantly less frequent (p=0.01) in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria, with an estimated 1-year event rate of 24.6% vs 49.1%. Patients with COAPT inclusion criteria had a 49% lower hazard of the composite endpoint (95% CI 12–70%, p=0.015). Heart failure hospitalization was significantly less frequent (p=0.039) in patients fulfilling COAPT selection criteria than in those who did not, with an estimated 1-year event rate of 19% vs. 36.8%. Patients with COAPT inclusion criteria had a 50% lower hazard for heart failure hospitalization (95% CI 1–75%, p=0.046). Of note, the 1-year all-cause mortality in our patients fulfilling COAPT inclusion criteria was lower compared to the renowned COAPT trial (10% vs. 19%). Conclusion In this single center study the outcome of patients with functional mitral regurgitation undergoing mitraclip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility. The remarkable difference in outcome between real-world patients and COAPT trial patients warrants further study to elucidate underlying causes, which might affect the transferability of the COAPT results.

scholarly journals 812 Prognostic impact of the COAPT inclusion and exclusion criteria in real-world patients with secondary mitral regurgitation undergoing MitraClip implantation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Serena Serratore ◽  
Alberto Polimeni ◽  
Annalisa Mongiardo ◽  
Carmen Spaccarotella ◽  
Sabato Sorrentino ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Selection Criteria ◽  
Composite Endpoint ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Inclusion Criteria ◽  
Heart Failure Hospitalization ◽  
Mitraclip Therapy

Abstract Aims The COAPT randomized trial has shown a huge benefit in the survival of patients with s heart failure and functional mitral regurgitation treated with MitraClip. However, patients in COAPT were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear. Methods The present study examined the clinical outcome in consecutive patients with symptomatic moderate-to-severe or severe MR of dominant functional aetiology undergoing MitraClip therapy by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction &gt;20%, left ventricular end-systolic dimension &lt;70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure &lt;70 mmHg, mitral valve orifice area &gt;4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). Results The composite endpoint of all-cause mortality or heart failure hospitalization and the endpoint of heart failure hospitalization were analysed. Among 118 patients who underwent MitraClip implantation 61% fulfilled the inclusion criteria of COAPT. The composite endpoint was significantly less frequent (P = 0.05) in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria, with an estimated 1-year event rate of 25% vs. 49%. Heart failure hospitalization was significantly less frequent (P = 0.04) in patients fulfilling COAPT selection criteria than in those who did not, with an estimated 1-year event rate of 19% vs. 36.8%. Conclusions In this single centre study the outcome of patients with functional mitral regurgitation undergoing MitraClip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility.

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