Left atrial volume index and outcome after transcatheter edge‐to‐edge valve repair for secondary mitral regurgitation

Iliadis, Christos; Kalbacher, Daniel; Lurz, Philipp; Petrescu, Aniela; Orban, Mathias; Puscas, Tania; Lupi, L; Stazzoni, Laura; Pires‐Morais, Gustavo; Koell, Benedikt; Besler, Christian; Ruf, T.; Stolz, Lukas; Tence, Noémie; Adamo, Marianna; Giannini, Cristina; Guerreiro, Cláudio; Hellmich, Martin; Baldus, Stephan; Schofer, Niklas; Thiele, Holger; Bardeleben, Ralph Stephan von; Hausleiter, Jörg; Karam, Nicole; Metra, Marco; Petronio, Anna Sonia; Melica, Bruno; Pfister, Roman

doi:10.1002/ejhf.2565

Cited by 12 publications

(13 citation statements)

References 31 publications

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“…Residual MR 1+ after MitraClip was associated with reduced risk of 1 year mortality, compared with residual MR 2+ and 3/4+ 188,189 . LA enlargement is a strong and independent predictor of adverse long‐term outcome after M‐TEER 77,190 . Among 221 patients with HFrEF and MR ≥ 3+ successfully treated with M‐TEER, 40% had an improvement in right ventricular (RV) function, and this finding was independently associated with lower risk of death or heart transplantation (HTx) [hazard ratio (HR) 0.52; 95% confidence interval (CI) 0.29–0.94; P = 0.030] 191 .…”

Section: Treatment Of Heart Failure With Reduced Ejection Fractionmentioning

confidence: 99%

Heart failure: an update from the last years and a look at the near future

et al. 2022

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In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.

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Section: Treatment Of Heart Failure With Reduced Ejection Fractionmentioning

confidence: 99%

Heart failure: an update from the last years and a look at the near future

et al. 2022

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“…Iliadis et al showed that the symptomatic benefit of the procedure is high regardless of baseline LAVi values. 14 The left atrial strain findings are thought-provoking. PMR patients had a significantly higher magnitude of left atrial strain at baseline compared with SMR regardless of phase, likely reflecting the underlying myocardial disease seen in SMR.…”

Section: Discussionmentioning

confidence: 99%

“…Our study population was characterized by baseline high LAVi values and no significant changes in LAVi were observed after the procedure. Iliadis et al showed that the symptomatic benefit of the procedure is high regardless of baseline LAVi values 14 …”

Section: Discussionmentioning

confidence: 99%

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

Prandi

Zaid

et al. 2022

Journal of Cardiovascular Medicine

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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.

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“…HF phenotypes of advanced disease [i.e. left atrium enlargement and RV dysfunction] represent independent predictors of adverse long-term outcome after M-TEER 108–110 . An improvement in RV function at early follow-up (median time 4 months) was observed in almost 40% of patients undergoing successful M-TEER and was associated with lower risk of both death/heart transplantation and HF hospitalization 110 .…”

Section: Comorbidities and Special Conditionsmentioning

confidence: 99%

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Cimino

Pancaldi

Tomasoni

et al. 2022

Journal of Cardiovascular Medicine

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Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

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Left atrial volume index and outcome after transcatheter edge‐to‐edge valve repair for secondary mitral regurgitation

Abstract: To investigate the role of left atrial volume index (LAVi) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER).

Cited by 12 publications

References 31 publications

Heart failure: an update from the last years and a look at the near future

Heart failure: an update from the last years and a look at the near future

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

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

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