Acute effect of edge-to-edge repair of mitral regurgitation on left heart mechanics and health status

Abstract

AimsExamine the impact of acute changes in left heart strain and volumes with percutaneous edge-to-edge MitraClip repair on improvement in health status assessed using Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score.MethodsChanges in left atrial strain, left ventricular (LV) global longitudinal strain (LVGLS), LV end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were evaluated in 50 patients undergoing MitraClip repair for symptomatic primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) on transthoracic echocardiography before and 1 month after MitraClip. Multivariable regression was used to evaluate changes in left heart strain and volumes as predictors of change in KCCQ-12 scores, adjusting for baseline clinical and echocardiographic characteristics.ResultsBoth PMR and SMR patients had significant increase in LVGLS and reduction in LVEDV and LVESV (P < 0.05) after MitraClip, reduction trend in left atrial conduit strain (PMR P = 0.053; SMR P = 0.12) but no significant change in LV ejection fraction. KCCQ-12 score improved significantly in both PMR (P < 0.001) and SMR cohorts (P < 0.001). Higher delta KCCQ-12 tertiles were associated with greater reduction in LVEDV (P = 0.022) after MitraClip. On multiple regression analysis, lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial strain conduit phase were associated with KCCQ-12 score improvement (P < 0.001).ConclusionThere is a significant increase in LVGLS and reduction in LVEDV, LVESV and left atrial strain conduit after edge-to-edge MitraClip repair in both PMR and SMR. Lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial conduit strain were associated with KCCQ-12 score improvement after MitraClip. Further studies are warranted to understand the mechanism and significance of our findings.

Left Atrium: A New Prognostic Marker and Therapeutic Target in Secondary Mitral Regurgitation?

“…53 Moreover, Ro et al described reduced LA conduit strain combined with decreased LV volumes in patients undergoing MitraClip, 1 month after the procedure. 54 A small study conducted by Scislo et al in patients undergoing TEER of the MV surprisingly showed no improvement in myocardial strains (LV, LA, RV) but deterioration of LARS in some subgroups. 55 Another study showed LA strain decrease after TEER but included only a small number of patients (25% of whom had SMR).…”

“…[ 53 ] Moreover, Ro et al described reduced LA conduit strain combined with decreased LV volumes in patients undergoing MitraClip, 1 month after the procedure. [ 54 ]…”

Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation

“…Mitral transcatheter edge-to-edge mitral valve repair (M-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, California, USA) represents an option for selected patients with functional mitral regurgitation (FMR), 1–4 having also been associated in some cases with improved left ventricular (LV) strain and volumes 5 . Intra-procedural evaluation of the hemodynamic effect of M-TEER in this setting is still a matter for debate.…”

Cardiovascular imaging updates and future perspectives

“…Indices of LV enlargement and function add a strong prognostic value. Recent studies suggest that global longitudinal strain has greater value than LVEF, although the cut-off is not uniform 23 . A TAPSE/PASP (pulmonary artery systolic pressure) ratio less than 0.36 mm/mmHg is strongly associated with an increased risk of mortality after transcatheter aortic valve implantation (TAVI).…”

“…Recent studies suggest that global longitudinal strain has greater value than LVEF, although the cut-off is not uniform. 23 A TAPSE/PASP (pulmonary artery systolic pressure) ratio less than 0.36 mm/mmHg is strongly associated with an increased risk of mortality after transcatheter aortic valve implantation (TAVI). Providing LV unloading, TAVI is associated with the improvement of both TAPSE, PASP and their ratio.…”