Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation

Malik, Umar; Ambrosy, Andrew P.; Ku, Ivy A.; Mishell, Jacob M.; Kar, Saibal; Lim, D. Scott; Whisenant, Brian; Cohen, David J.; Arnold, Suzanne V.; Kotinkaduwa, Lak N.; Lindenfeld, JoAnn; Abraham, William T.; Stone, Gregg W.

doi:10.1016/j.jcin.2020.07.030

Cited by 18 publications

(7 citation statements)

References 23 publications

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“…Altogether, this subanalysis, as well as those published previously [5,18], consistently show a neutral effect of TMVr on all-cause death or unplanned hospitalization for heart failure at 24 months in all MITRA-FR subsets. This greatly contrasts with COAPT findings that consistently report a beneficial effect of TMVr in all subsets [19][20][21]. The present analyses illustrate the critical need to better identify the subsets of patients that will benefit from TMVr.…”

Section: Discussioncontrasting

confidence: 87%

Impact of procedural success on clinical outcome after MitraClip: Results from the MITRA-FR trial

Messika–Zeitoun

Attias

Piriou

et al. 2022

Archives of Cardiovascular Diseases

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Section: Discussioncontrasting

confidence: 87%

Impact of procedural success on clinical outcome after MitraClip: Results from the MITRA-FR trial

Messika–Zeitoun

Attias

Piriou

et al. 2022

Archives of Cardiovascular Diseases

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“…Subanalyses of the COAPT trial confirm the positive response to TEER in several patient subgroups; [339][340][341][342][343] conversely, the effect of the interventional treatment was neutral throughout all subgroups in an echocardiographic subanalyses of the MITRA-FR trial. 344 The conflicting results of these two trials have generated considerable discussion.…”

Section: Indications For Interventionmentioning

confidence: 99%

2021 ESC/EACTS Guidelines for the management of valvular heart disease

Vahanian¹,

Beyersdorf²,

Praz³

et al. 2022

EuroIntervention

570

581

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The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of health care or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and the patient's caregiver where appropriate and/or necessary. Nor do the ESC Guidelines exempt health professionals from taking careful and full consideration of the relevant official updated recommendations or guidelines issued by the competent public health authorities in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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“… 16 From a physiological point of view, successful MR repair is associated with LV reverse remodelling, reduction in pulmonary pressure and possibly improvement of forward stroke volume. 17 , 18 The latter has been shown at rest by haemodynamic monitoring shortly after pMVR. 19 At present, data on pMVR‐induced forward stroke volume changes in the long term, both at rest and during exercise, are lacking.…”

Section: Introductionmentioning

confidence: 93%

“…Moreover, a severely impaired exercise performance seems to be associated with poor pMVR outcome at least in FMR patients 16 . From a physiological point of view, successful MR repair is associated with LV reverse remodelling, reduction in pulmonary pressure and possibly improvement of forward stroke volume 17,18 . The latter has been shown at rest by haemodynamic monitoring shortly after pMVR 19 .…”

Section: Introductionmentioning

confidence: 99%

Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair

et al. 2021

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Aims Changes in peak exercise oxygen uptake (VO2) and cardiac output (CO) 6 months after successful percutaneous edge‐to‐edge mitral valve repair (pMVR) in severe primary (PMR) and functional mitral regurgitation (FMR) patients are unknown. The aim of the study was to assess the efficacy of pMVR at rest by echocardiography, VO2 and CO (inert gas rebreathing) measurement and during cardiopulmonary exercise test with CO measurement. Methods and results We evaluated 145 and 115 patients at rest and 98 and 66 during exercise before and after pMVR, respectively. After successful pMVR, significant reductions in MR and NYHA class were observed in FMR and PMR patients. Cardiac ultrasound showed reverse remodelling (left ventricular end‐diastolic volume from 158 ± 63 mL to 147 ± 64, P < 0.001; ejection fraction from 51 ± 15 to 48 ± 14, P < 0.001; pulmonary artery systolic pressure (PASP) from 43 ± 13 to 38 ± 8 mmHg, P < 0.001) in the entire population. These changes were significant in PMR (n = 62) and a trend in FMR (n = 53), except for PASP, which decreased in both groups. At rest, CO and stroke volume (SV) increased in FMR with a concomitant reduction in arteriovenous O2 content difference [ΔC(a‐v)O2]. Peak exercise, CO and SV increased significantly in both groups (CO from 5.5 ± 1.4 L/min to 6.3 ± 1.5 and from 6.2 ± 2.4 to 6.7 ± 2.0, SV from 57 ± 19 mL to 66 ± 20 and from 62 ± 20 to 69 ± 20, in FMR and PMR, respectively), whereas peak VO2 was unchanged and ΔC(a‐v)O2 decreased. Conclusions These data confirm pMVR‐induced clinical improvement and reverse ventricular remodelling at a 6‐month analysis and show, in spite of an increase in CO, an unchanged exercise performance, which is achieved through a ‘more physiological’ blood flow distribution and O2 extraction behaviour. Direct rest and exercise CO should be measured to assess pMVR efficacy.

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Baseline Functional Capacity and Transcatheter Mitral Valve Repair in Heart Failure With Secondary Mitral Regurgitation

Cited by 18 publications

References 23 publications

Impact of procedural success on clinical outcome after MitraClip: Results from the MITRA-FR trial

Impact of procedural success on clinical outcome after MitraClip: Results from the MITRA-FR trial

2021 ESC/EACTS Guidelines for the management of valvular heart disease

Rest and exercise oxygen uptake and cardiac output changes 6 months after successful transcatheter mitral valve repair

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