Atrial Functional Mitral Regurgitation

Deferm, Sébastien; Bertrand, P.; Verbrugge, Frederik H.; Verhaert, David; Rega, Filip; Thomas, James D.; Vandervoort, Pieter M.

doi:10.1016/j.jacc.2019.02.061

Cited by 284 publications

(214 citation statements)

References 54 publications

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“…7 One of the components of SMR is dilation of the mitral valve annulus (MA) and increased left atrial volume (LAV). 8 The Carillon Mitral Contour System ® (CMCS; Cardiac Dimensions, Inc., Kirkland, WA, USA) is the only device having CE approval to treat mitral regurgitation by addressing MA dilation through indirect annuloplasty, utilizing the proximity of the coronary sinus (CS) to the MA. Several studies have shown the safety and efficacy of the device with reduction in mitral regurgitation grade and improvement in exercise capacity, quality of life, [9][10][11] and left ventricular (LV) reverse remodelling.…”

Section: Introductionmentioning

confidence: 99%

“…One of the components of SMR is dilation of the mitral valve annulus (MA) and increased left atrial volume (LAV) 8 . The Carillon Mitral Contour System ® (CMCS; Cardiac Dimensions, Inc., Kirkland, WA, USA) is the only device having CE approval to treat mitral regurgitation by addressing MA dilation through indirect annuloplasty, utilizing the proximity of the coronary sinus (CS) to the MA.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

et al. 2020

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Aims Mitral annuloplasty using the Carillon Mitral Contour System (CMCS) reduces secondary mitral regurgitation (SMR) and leads to reverse left ventricular remodelling. The aim of this study was to evaluate the effect of the CMCS on the mitral valve annulus (MA) and left atrial volume (LAV). Methods and results We retrospectively evaluated the data of all patients treated with the CMCS at our centre. Using transthoracic echocardiography, MA diameters were assessed by measuring the anterolateral to posteromedial extend (ALPM) and the anterior to posterior (AP) dimensions, respectively. Also, LAV and left ventricular end-diastolic volume (LVEDV) were assessed. Patients were examined at three time points: baseline, at 20-60 days (30dFUP), and at 9-15 months (1yFUP), using paired analysis. From July 2014 until March 2019, 75 cases of severe SMR were treated using CMCS. Cases in which other devices were used in combination (COMBO therapy, n = 35) or in which the device could not be implanted (implant failure, n = 3) were excluded, leaving 37 patients in the present analysis. Analysis at 30dFUP showed a significant reduction of 16% in the mean ALPM diameter (7.27 ± 5.40 mm) and 15% in the AP diameter (6.57 ± 5.33 mm). Analysis of LAV also showed a significant reduction of 21% (36.61 ± 82.67 mL), with no significant change in LVEDV. At 1yFUP, the reduction of both the mean ALPM diameter of 14% (6.24 ± 5.70 mm) and the mean AP diameter of 12% (5.46 ± 4.99 mm) remained significant and stable. The reduction in LAV was also maintained at 23% (37.03 ± 56.91 mL). LAV index was significantly reduced by 17% at 30dFUP (15.44 ± 40.98 mL/m 2) and by 13% at 1yFUP (11.56 ± 31.87 mL/m 2), respectively. LVEDV index showed no significant change at 30dFUP and a non-significant 10% reduction at 1yFUP (17.75 ± 58.79 mL/m 2). Conclusions The CMCS successfully treats symptomatic SMR with a stable reduction of not only the AP diameter of the MA, but the current study also demonstrates an additional reduction of the ALPM dimension at both 30dFUP and 1yFUP. We have also shown for the first time that LAV and LAV index are significantly reduced at both 30dFUP and 1yFUP and a non-significant positive remodelling of the LVEDV. This positive left atrial remodelling has not been looked for and demonstrated in earlier randomized studies of CMCS.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

et al. 2020

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“…Besides ischemic and non-ischemic subgroups, SMR etiologies can be separated by LV-LA function. Among those is ASMR, as previously mentioned [54,65,66] . While our knowledge of anatomy and pathophysiology of ASMR is growing, specific predictors for all-cause mortality after TMVr are so far lacking [66] .…”

Section: Smr Only Collectivementioning

confidence: 99%

“…Left atrial dysfunction in SMR patients recently gained attention as this condition can lead to MR in absence of severe systolic LV dysfunction. This pathology called atrial secondary mitral regurgitation (ASMR) is caused by either atrial fibrillation or heart failure with preserved ejection fraction (HFpEF), as both increase LA pressure and volume leading to annular flattening and alteration of left ventricular atrioventricular hemodynamics [54] . As HFpEF patients with SMR were excluded from large controlled randomized trials (COAPT or MITRA-FR) [12,13] , but undergo TMVr procedure in real-world clinical practice, impact of ASMR on survival and procedural success warants further investigation.…”

Section: Smr Only Collectivementioning

confidence: 99%

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Stolz¹,

Orban²,

Braun³

et al. 2020

Mini-invasive Surg

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“…Th is raises the question whether the MV geometrical conformation is more dependent on the LA morphology than on the LV volumes and function. Th e concept of atrial functional mitral regurgitation is currently regarded as distinct from the secondary mitral regurgitation which appears as a consequence of LV deformation 8 . Future studies are needed to establish the intimate relationships between MV geometrical distortion, LV and LA morphology and function.…”

Section: Relationship Between MV Geometry and Lv And La Parametersmentioning

confidence: 99%

Mitral Valve Remodeling After Acute Myocardial Infarction – A Longitudinal Three-Dimensional Echocardiography Study

Onciul¹,

PASCAL²,

Guzu³

et al. 2019

Rev. Med. Mod.

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Background:Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR. However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI. Methods and results: Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the fi rst 7 days after a fi rst ST elevation myocardial infarction (STEMI), and after 4 years of follow-up. The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33 cm, p<0.05), independently of the presence or severity of IMR. The posterior leaflet length and area got smaller over time (1.53±0.51 cm vs 1.27±0.33 cm; p<0.05 and 5.65±1.58 cm 2 vs 4.88±1.65 cm 2 ; p<0.05, respectively). The tenting height and area were smaller at follow-up (9.06±2.6 mm vs 7.84±2.61 mm, p<0.05; and 1.88±0.6 cm 2 vs 1.57±0.5 cm 2 ; p<0.05, respectively). A larger tenting at follow-up correlated with 3D left atrial (LA) volumes, but not with LV volumes and ejection fraction. Conclusions: MV geometry changes over time even in patients with non-severe IMR. The MV healing process consists in annulus flattening associated with improved tenting. RezumatContext: Cercetările recente au arătat că mecanismele care stau la baza regurgitării mitrale ischemice (RMI) în contextul infarctului miocardic (IM) acut sunt diferite faţă de mecanismele RMI cronice. Totuși, există puţine informaţii referitoare la modifi cările în timp ale geometriei valvei mitrale după un IM acut. Metode și rezultate: Geometria valvei mitrale a fost analizată prin ecocardiografi e tridimensională (3D) la 30 de pacienţi în primele 7 zile după infarct cu supradenivelare de segment ST (STEMI), și după 4 ani de urmărire. Diametrele și aria inelului mitral nu s-au modifi cat în timp, totuși inelul mitral s-a aplatizat progresiv (diferenţa medie a înălţimii inelului 0,19±0,33 cm, p<0,05), independent de prezenţa sau severitatea RMI. Lungimea și aria foiţei mitrale posterioare a devenit mai mică în timp (1,53±0,51 cm vs 1,27±0,33 cm; p<0,05 și respectiv 5,65±1,58 cm 2 vs 4,88±1,65 cm 2 ; p<0,05). Înălţimea și aria de tenting au devenit mai mici în timp (9,06±2,6 mm vs 7,84±2,61 mm, p<0,05; și respectiv 1,88±0,6 cm 2 vs 1,57±0,5 cm 2 ; p<0,05). Parametrii de tenting mai mari la vizita fi nală s-au corelat cu volumele 3D ale atriului stâng (AS) dar nu cu volumele și fracţia de ejecţie a ventriculului stâng. Concluzii: Geometria valvei mitrale se modifi că ORIGINAL PAPER Sebastian ONCIUL et al.

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Atrial Functional Mitral Regurgitation

Cited by 284 publications

References 54 publications

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

Transcatheter indirect mitral annuloplasty induces annular and left atrial remodelling in secondary mitral regurgitation

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

Mitral Valve Remodeling After Acute Myocardial Infarction – A Longitudinal Three-Dimensional Echocardiography Study

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