Clinical impact of mitral regurgitation in aortic valve stenosis: Insight from effective regurgitant orifice area

2021 ◽  
Author(s):  
Caterina Maffeis ◽  
Giovanni Benfari ◽  
Stefano Nistri ◽  
Flavio L. Ribichini ◽  
Andrea Rossi
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Stenosis ◽  
Clinical Impact ◽  
Orifice Area ◽  
Regurgitant Orifice Area

Mitral Effective Regurgitant Orifice Area Predicts Pulmonary Artery Pressure Level in Patients with Aortic Valve Stenosis

2018 ◽  
Vol 31 (5) ◽  
pp. 570-577.e1 ◽  
Author(s):  
Giovanni Benfari ◽  
Stefano Nistri ◽  
Pompilio Faggiano ◽  
Marie-Annick Clavel ◽  
Caterina Maffeis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Aortic Valve Stenosis ◽  
Pressure Level ◽  
Orifice Area ◽  
Artery Pressure ◽  
Regurgitant Orifice Area

5942Clinical outcomes and prognostic implications of effective regurgitant orifice area. Defining severe mitral regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J M Monteagudo Ruiz ◽  
A Gonzalez Gomez ◽  
R Hinojar Baydes ◽  
E Casas Rojo ◽  
A Garcia Martin ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Cardiac Death ◽  
Cox Regression ◽  
Strong Predictor ◽  
Optimal Threshold ◽  
Orifice Area ◽  
End Point ◽  
Increased Risk ◽  
Secondary Mr ◽  
Regurgitant Orifice Area

Abstract Background Previous studies showed that the effective regurgitant orifice area (EROA) is a strong predictor of clinical outcomes. However, there is controversy over the optimal threshold that identifies patients at high-risk, especially in secondary mitral regurgitation (MR). Purpose To determine the optimal EROA threshold that identifies a subgroup patients with an increased risk of cardiac death and hospitalization for heart failure (HF), in both, primary and secondary MR. Methods A total of 6022 consecutive transthoracic echocardiograpic studies were analysed. Patients with significant MR were prospectively included. The EROA was calculated by the PISA method. Each patient was followed up for three years. Cox regression was performed to study predictors of the combined end-point. ROC curve analysis was performed to determine the optimal cut-off values of EROA. Results Significant primary MR was found in 115 patients (62%), whereas significant secondary MR was described in 71 studies (38%). In primary MR, the optimal threshold of EROA for predicting the combined end-point was 45mm2 (Sn=85.7%; Sp=82.2%). After adjusting for NYHA class, ejection fraction and chronic kidney disease, an EROA ≥45mm2 was strongly associated with cardiac death and admissions due to HF (HR 15.65, 95% CI 4.34–56.47, p<0.001). Regarding secondary MR, the optimal cut-off value was 21mm2 (Sn=75.0%; Sp=61.8%) and the adjusted HR was 2.57 (95% CI 1.03–6.37, p=0.042). Sensitivity and specificity curves Conclusions Our study demonstrates that an EROA of at least 45mm2 in primary MR or of at least 21mm2 in secondary MR is independently associated with a significantly increased risk of cardiac death and hospitalization for HF.

scholarly journals 428 Prognostic implications of the relationship between effective regurgitant orifice area and left ventricle end diastolic volume in patients with functional mitral regurgitation treated with MitraClip

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Melillo ◽  
C Godino ◽  
F Ancona ◽  
A Sisinni ◽  
S Stella ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Clinical Outcome ◽  
Mitral Regurgitation ◽  
Primary Outcome ◽  
Functional Mitral Regurgitation ◽  
Orifice Area ◽  
End Diastolic Volume ◽  
Prognostic Implications ◽  
Regurgitant Orifice Area ◽  
The Relationship

Abstract Funding Acknowledgements none Background The distinction between proportionate and disproportionate functional mitral regurgitation (FMR), based on the relationship between effective regurgitant orifice area (EROA) and left ventricle end diastolic volume (LVEDV), has recently been proposed as a possible new clinical and physiopathological framework to identify patients that could likely benefit from transcatheter mitral repair. Purpose The aim of our study was to explore the possible prognostic implications of the EROA/LVEDV ratio in patients with FMR treated with MitraClip. Methods – Baseline EROA/LVEDV was calculated in 137 patients with at least moderate-to-severe, symptomatic FMR treated with MitraClip. All patients underwent clinical, biochemichal and echocardiographic evaluation before MitraClip. EROA was calculated using PISA method. The primary outcome was a composite end-point of all-cause death or re-hospitalization for heart failure (HF). Results – The median follow-up was 1.1 years. The primary outcome occurred in 59 patients (43 %). Population study showed a LVEDVi 113.52± 32.16 mL/m2, LVEF 29.75± 10.06% and EROA 39.45± 15.43 mm2.. The cut-off value of EROA/LVEDV ratio for primary outcome, identified by receiver operating characteristic curve, was 0.15 (AUC 0,65, p = 0.002) with a sensitivity and specificity of 78% and 52%, respectively. Patients were divided in two groups according to the identified cut-off. Patients with higher ratio (Group I, n = 88) presented a less dilated LV (LVEDVi: 105.1 ± 29.6 mL/m2 vs 128.2 ± 31.9 mL/m2, p &lt; 0.001; LVESVi: 73.1 ± 27.7 mL/m2 vs 94.9 ± 29.05 mL/m2, p &lt; 0.001), and a more severe MR (EROA: 47.9 ± 12.1 mm2 vs 25.1 ± 8.3 mm2, p &lt; 0.001; vena contracta: 7.2 ± 1.3 mm vs 6.5 ± 1.3 mm, p = 0.008). There were no significant differences of left ventricle ejection fraction, right ventricle systolic function and systolic pulmonary pressure between the groups. At univariate analysis, EROA/LVEDV ratio &gt;0.15 (HR = 2.223, 95% CI 1.121-4.411, p = 0.022), baseline evidence of atrial fibrillation (HR = 1.949, 95% CI 1.156-3.283, p = 0.012) and baseline pro-BNP (HR= 1.000, 95% CI 1.000-1.000, p = 0,001) were associated with a worse clinical outcome. At multivariate Cox-regression analysis, both EROA/LVEDV ratio &gt;0.15 and baseline pro-BNP values were identified as independent predictors (HR 2.941, 95% CI 1.035-8.353, p = 0.043; HR = 1.000, 95% CI 1.000-1.000, p = 0.002, respectively). At Kaplan-Meier survival analysis, patients with EROA/LVEDV &gt;0.15 had a significant lower freedom from composite endpoint (log-rank χ2 =5.517, p= 0.019; Fig. 1). Conclusion Our data show that EROA/LVEDV ratio was an independent predictor of adverse clinical outcome in FMR patients treated with MitraClip. This preliminary experience shows that this index could help to identify subgroups of patients with potential different clinical benefits from Mitraclip therapy. However, further and extended data are needed to provide more precise evidence. Abstract 428 Figure. Fig. 1

Accuracy and feasibility of a simplified approach to assess the regurgitant orifice area in patients with mitral regurgitation

2004 ◽  
Vol 20 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Luigi Ascione ◽  
Mario De Michele ◽  
Maria Accadia ◽  
Salvatore Rumolo ◽  
Lucia Damiano ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Orifice Area ◽  
Simplified Approach ◽  
Regurgitant Orifice Area

scholarly journals Three-dimensional echocardiographic planimetry of maximal regurgitant orifice area in myxomatous mitral regurgitation: intraoperative comparison with proximal flow convergence

1998 ◽  
Vol 32 (2) ◽  
pp. 432-437 ◽  
Author(s):  
Christian S. Breburda ◽  
Brian P. Griffin ◽  
Min Pu ◽  
Leonardo Rodriguez ◽  
Delos M. Cosgrove ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Orifice Area ◽  
Flow Convergence ◽  
Regurgitant Orifice Area

Successful MitraClipTM implantation in a 15-year-old patient with multiple prior cardiac surgeries

2012 ◽  
Vol 23 (4) ◽  
pp. 620-622 ◽  
Author(s):  
Matthias Gorenflo ◽  
Hugo A. Katus ◽  
Raffi Bekeredjian
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Clinical Improvement ◽  
Mitral Valve Repair ◽  
Aortic Valve Stenosis ◽  
Mitral Valve Regurgitation ◽  
Male Adolescent ◽  
Valve Regurgitation ◽  
Valve Repair

AbstractPercutaneous edge-to-edge mitral valve repair using the MitraClipTM has not been used in children. The patient in this reported case was a 15-year-old male adolescent who presented postnatally with severe aortic valve stenosis and dysplasia of the mitral valve. The boy underwent surgical valvuloplasty at the age of 3 months and an aortoventriculoplasty with three re-operations. At the age of 15 years, he developed severe mitral valve regurgitation. Owing to high surgical risks, a MitraClipTM was implanted with a reduction of mitral regurgitation from grade 4+ to 2+, translating into a rapid clinical improvement.

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