Acute reverse annular remodeling during MitraClip® therapy predicts improved clinical outcome in heart failure patients: a 3D echocardiography study

Abstract

BackgroundTranscatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip® therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients.MethodsTMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip® implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software. Patients underwent clinical and echocardiographic evaluation at baseline and after 6 months. At follow-up, the patients were allocated into two groups according to their improvement in New York Heart Association (NYHA) functional class: a Low Responder group with ΔNYHA <1.5 (n = 25); and a High Responder group with ΔNYHA ≥1.5 (n = 20).ResultsAt 6-month follow-up, data analysis revealed that while mitral regurgitation was reduced significantly in both groups, only the High Responder group had experienced significant downsizing of the 3D circumference (137 ± 14 mm to 126 ± 13 mm; p < 0.01) and the anterior-to-posterior diameter (33 ± 5 mm to 29 ± 4 mm; p < 0.01) of the mitral annulus during the intervention. Furthermore, only the High Responder group with reverse annular remodeling as shown had substantial advances in quality of life (Minnesota living with heart failure questionnaire: 55 ± 10 to 34 ± 14 points; p < 0.01) and functional status (6-min walk distance: 290 ± 104 m to 462 ± 111 m; p = 0.07).ConclusionOur study demonstrates that instantaneous left ventricular annular remodeling during MitraClip® implantation is associated with improved clinical outcome of heart failure patients with functional mitral regurgitation. Trial registration The study was approved by the local ethics committee (Study Number 4497R, Registration ID: 2013121585). Trial registration: NCT02033811 Retrospectively registered January 9, 2014.

Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system

“…As shown by others, assessment of global left ventricular longitudinal strain might better reflect LV systolic function in patients with MR after MV repair. Our findings are in line with previous studies, which reported absence or only minor changes of the LVEF despite significant improvement in the end‐diastolic pressure–volume relationship. This indicates that the beneficial effect of MC might less be reflected by improved LVEF, but rather due to the redirection of the regurgitation volume.…”

“…LVRR after MC therapy occurred in 49% of the patients. Even though prior publications used the 6‐months period to assess for LVRR, we included in the final analysis only patients who completed both 6‐ and 12‐months follow‐up in order to evaluate whether the LVRR persisted during longer follow‐up. Indeed, a decrease in left ventricular dimensions became already evident after 6 months and further improved after 12 months, underlining the consistency of the study findings.…”

“…Over the past years, MitraClip (MC) therapy has emerged as a treatment option for both degenerative (DMR) and functional mitral regurgitation (FMR) in high‐risk patients. Reduction of mitral regurgitation (MR) grade by MC has been shown to induce left ventricular reverse remodeling (LVRR), known to be associated with survival benefit after various medical therapies including cardiac resynchronization therapy (CRT) and surgical valve repair . FMR and DMR present distinct pathophysiology, thus it is unclear whether a similar magnitude of reverse remodeling and hemodynamic response can be expected after successful MC therapy.…”

Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

“…The primary limitation of this study is that our calculations were not optimized with experimental data obtained after MitraClip. On the other hand, SL annular dimension at end-diastole decreases between 2.8 to 4 mm in patients with FMR after MitraClip [36–38] and Lurz et al found that the MRI-measured radial strain averaged across all sectors at the mitral valve level decreased from 15.4 to 9.6% after MitraClip in a cohort of mostly FMR patients. [39] These findings show that our simulations are in agreement with clinical results.…”