Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement

Abstract

The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre-and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre-and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre-and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.

Impact of transcatheter aortic valve implantation on coexistent mitral regurgitation parameters

“…Heretofore, the most widely used parameters are effective regurgitation orifice (MR-ERO) and regurgitation volume (MR-Vol)derived with the PISA method. Despite several limitations such as the inherent assumption of hemispherical PISA shape or difficult assessment of multi-jet regurgitations, they remain the most acknowledged in daily clinical practice [10,11]. We, therefore, sought to quantitatively assess the impact of TAVI on coexistent MR using both MR-ERO and MR-Vol.…”

The Prognosis of Baseline Mitral Regurgitation in Patients with Transcatheter Aortic Valve Implantation

“…Of all the TAVI recipients with concomitant MR, functional MR consisted of 36% to 92% of the group [5][6][7][8][9]. Degenerative annular or valvular calcification was the leading cause of organic MR (92%), while 85% of functional MR was secondary to severe aortic stenosis in this group of patients [9]. The reported prevalence of significant (≥moderate) MR varies between 11.5% and 36.8% in cohorts of TAVI patients [4,6,7,10].…”

“…In a national registry-based cohort, mild, moderate, and severe mitral regurgitation (MR) at baseline were noted in 47.9%, 31.3% and 5.4% of patients who underwent the procedure, respectively [4]. Of all the TAVI recipients with concomitant MR, functional MR consisted of 36% to 92% of the group [5][6][7][8][9]. Degenerative annular or valvular calcification was the leading cause of organic MR (92%), while 85% of functional MR was secondary to severe aortic stenosis in this group of patients [9].…”

Prognostic relevance of mitral and tricuspid regurgitation after transcatheter aortic valve implantation: Impact of follow-up time point for decision-making

“…The missing link between baseline MR might be because the majority of MR is functional and probably, at least in part, caused by AS ( 24 , 25 ). Thus, MR severity is likely to be extremely dynamic after TAVI in response to a complex process of reverse remodeling secondary to decreased afterload of the left ventricle ( 26 , 27 ).…”