2D/3D echocardiographic determinants of left ventricular reverse remodelling after MitraClip implantation.

AIMS The aim of this study was to describe incidence and determinants of left ventricular reverse remodelling (r-LVR) at 6 months follow-up after MitraClip implantation in patients with secondary severe mitral regurgitation (MR) and reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS Forty-five patients, undergoing MitralClip implantation with low ejection fraction and high surgical risk were enrolled in this study. Three of them died before the scheduled 6 months follow-up period and one patient had cardiac surgery due to MitraClip detachment. All patients underwent transthoracic 2D and 3D echocardiography before and 6 months after the procedure. A significant MR severity reduction and an improvement in New York Heart Association (NYHA) class were detected in all patients. The study population was divided in two groups according to the presence of r-LVR (51%, n = 23 patients) or not (non-rLVR group, 18 patients). Non-significant differences in MR aetiology and number of clips implanted were found. Left ventricular reverse remodelling patients showed significant lower values of logistic EuroSCORE and STS score, left ventricular end-diastolic volume index (LVEDV/i), right ventricular end systolic area, and pulmonary artery systolic pressure (PASp) at baseline evaluation. At multivariable analysis, baseline PASp value resulted to be the only independent predictor of r-LVR [odds ratio 95% confidence interval 0.94 (0.89-0.99), P = 0.021]. In r-LVR patients, a significant improvement in LVEF and global longitudinal strain and a reduction in left atrial volume index were detected after 6 months, whereas in non-rLVR subgroup a significant increase in both LVEDV/i and left ventricular end-systolic volume index was observed at follow-up. CONCLUSION Even if a reduction of MR was detected in all patients after MitralClip implant, our findings suggest that end-stage patients presenting with higher left ventricular volumes, logistic scores, and PASp may not benefit from the procedure at longer follow-up in terms of left ventricular function.

[1]  Jeroen J. Bax,et al.  2017 ESC/EACTS Guidelines for the management of valvular heart disease. , 2017, European heart journal.

[2]  A. Diegeler,et al.  Hemodynamic Improvement at Three Months after MitraClip® Treatment in End-Stage Heart Failure Patients with Functional Mitral Regurgitation. , 2016, The Journal of heart valve disease.

[3]  T. Rassaf,et al.  Left Atrial and Left Ventricular Function and Remodeling Following Percutaneous Mitral Valve Repair. , 2016, The Journal of heart valve disease.

[4]  G. Tanzilli,et al.  Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[5]  Victor Mor-Avi,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, European heart journal cardiovascular Imaging.

[6]  H. Katus,et al.  One year clinical efficacy and reverse cardiac remodelling in patients with severe mitral regurgitation and reduced ejection fraction after MitraClip© implantation , 2013, European journal of heart failure.

[7]  H. Katus,et al.  Percutaneous edge-to-edge repair of mitral regurgitation as a bail-out strategy in critically ill patients. , 2013, The Journal of invasive cardiology.

[8]  C. Tamburino,et al.  Left cardiac chambers reverse remodeling after percutaneous mitral valve repair with the MitraClip system. , 2012, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[9]  E. Foster,et al.  Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study. , 2012, Journal of the American College of Cardiology.

[10]  V. Thourani,et al.  Percutaneous Repair or Surgery for Mitral Regurgitation , 2012 .

[11]  M. Cheitlin.  Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy , 2012 .

[12]  G. Gravlee.  Acute Safety and 30-Day Outcome After Percutaneous Edge-to-Edge Repair of Mitral Regurgitation in Very High-Risk Patients , 2012 .

[13]  J. Crestanello.  Surgical Approach to Mitral Regurgitation in Chronic Heart Failure: When Is It an Option? , 2012, Current Heart Failure Reports.

[14]  W. Rottbauer,et al.  Acute safety and 30-day outcome after percutaneous edge-to-edge repair of mitral regurgitation in very high-risk patients. , 2011, The American journal of cardiology.

[15]  M. Enriquez-Sarano,et al.  Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy , 2011, Heart.

[16]  T. Meinertz,et al.  MitraClip® therapy in patients with end‐stage systolic heart failure , 2011, European journal of heart failure.

[17]  J. Oh,et al.  Atrioventricular Reverse Remodeling After Valve Repair for Chronic Severe Mitral Regurgitation: 1‐Year Follow‐Up , 2010, Clinical cardiology.

[18]  H. Reichenspurner,et al.  Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction. , 2010, European heart journal.

[19]  Antonio Colombo,et al.  Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting , 2010, European heart journal.

[20]  Scott Lim,et al.  Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. , 2009, Journal of the American College of Cardiology.

[21]  F. Fedele,et al.  Incidence, determinants, and prognostic value of reverse left ventricular remodelling after primary percutaneous coronary intervention: results of the Acute Myocardial Infarction Contrast Imaging (AMICI) multicenter study , 2008, European heart journal.

[22]  E. Foster,et al.  Percutaneous mitral valve repair using the edge-to-edge technique: six-month results of the EVEREST Phase I Clinical Trial. , 2005, Journal of the American College of Cardiology.

[23]  C. Rihal,et al.  Mitral regurgitation in patients with advanced systolic heart failure. , 2004, Journal of cardiac failure.

[24]  C. O'connor,et al.  Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. , 2003, The American journal of cardiology.