Proportionate and Disproportionate Functional Mitral Regurgitation

Grayburn, Paul A.; Sannino, Anna; Packer, Milton

doi:10.1016/j.jcmg.2018.11.006

Cited by 521 publications

(200 citation statements)

References 33 publications

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“…16 Patients with severe left ventricle dysfunction may be further categorized according to MI severity, and whether it is proportionate or disproportionate to the degree of ventricular dysfunction ( Figure 4). 17 Medical management aimed at decreasing left ventriclar volume overload (such as neurohormonal blockers) are effective in proportionate MI but no so much in disproportionate MI. In contrast, procedures aimed to improving mitral valve function (such as cardiac resynchronization and mitral valve repair) are effective in patients with disproportionate MI.…”

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

“…2019;12(2):353-62. 17 https://doi.org/10.1016/j.jcmg.2018.11.006. Figure 2; Relationship between EROA and LVEDV illustrating domains that define disproportionately severe, proportionately severe, and nonsevere functional mitral regurgitation; p. 357.…”

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

“…The equation for the proportional relation corresponds to effective regurgitant orifice area divided by left ventricle enddiastolic volume (ratio=0.13-0.14). 16,17 Source: Grasso C, Popolo Rubbio A. The PASCAL transcatheter mitral valve repair system for the treatment of mitral regurgitation: another piece to the puzzle of edge-to-edge technique.…”

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

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Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Ribeiro¹,

Júnior²,

Abizaid³

2020

J Transcat Intervent

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Mitral insufficiency is one of the most common acquired heart valve diseases and a common cause of heart failure, often in response to mitral annulus dilation. In such cases, the condition is referred to as functional or secondary and may be associated with ischemic heart disease or other dilated cardiomyopathies of varying etiology. Mitral valve insufficiency is common among older patients or individuals with several comorbidities, who are often not eligible for conventional mitral valve surgery due to high risk of intraoperative death and complications. Surgical outcomes (valve repair or replacement) may also be limited, particularly in patients with functional mitral insufficiency (class IIb indication according to most international guidelines). Several less invasive clip-based transcatheter mitral valve repair techniques have been developed. These have been addressed in several randomized trials in the last few years, such as the EVEREST-II, the MITRA-FR and the COAPT trials. Positive COAPT trial outcomes supported the indication of mitral clip procedures in functional mitral regurgitation patients with favorable anatomy, who remain symptomatic despite optimal medical treatment. Patients with "disproportionate" mitral insufficiency (i.e., large degree of mitral regurgitation relative to ventricular dysfunction) are those who benefit most from the intervention, with lower rates of hospital readmission and death. These outcomes prompted the incorporation of novel technologies (MitraClip® NTR, MitraClip® XTR and Pascal). Major features of these devices, such as longer clip arms, capability of independent grasping of anterior and posterior leaflets, and wider arm width range are reviewed in detail in this article.

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Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

Section: Recent Trials Addressing Mitraclip® Use In Secondary or Funcmentioning

confidence: 99%

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Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Ribeiro¹,

Júnior²,

Abizaid³

2020

J Transcat Intervent

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“…[21][22][23] Indeed, a mean EROA is expected function of LV volumes: greater is the LV volume, greater becomes the MR (Figures 1-5). In patients with LV dysfunction undergoing CRT, the absence of LV contractile reserve is associated a poor outcome and a limited extent of LV reverse remodeling.…”

Section: Pmvr and Cardiac Remodelingmentioning

confidence: 99%

“…Another explanation which emerged to explain differences between MITRA-Fr and COAPT trials is the pattern "proportionate" or "disproportionate" of MR severity with respect to LV volumes. [21][22][23] Indeed, a mean EROA is expected function of LV volumes: greater is the LV volume, greater becomes the MR (Figures 1-5). In COAPT study, patients treated Abbreviations: GLS = global longitudinal strain; LVEF = left ventricular ejection fraction; LVESVi = left ventricular end-systolic volume index; TAPSE = tricuspid annular plane systolic excursion.…”

Section: Pmvr and Cardiac Remodelingmentioning

confidence: 99%

Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

et al. 2019

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Aims Functional mitral regurgitation (FMR) is associated with poor outcome in systolic heart failure (HF) patients. Percutaneous edge‐to‐edge mitral valve repair (PMVR) in Mitra‐Fr study failed to prove any beneficial effect over optimal medical treatment (OMT) but win in COAPT study. Nevertheless, little is known about the effect of PMVR on LV performance and mechanics in HF patients with severe secondary MR. Method and results Thirty‐seven patients with severe FMR undergoing PMVR were included and compared (according to indices of LV myocardial function and the relationship between LV‐size and the degree of regurgitation) to nineteen patients with FMR treated by OMT. Both groups were clinically comparable. At 6‐month follow‐up, cardiac index such as LV global constructive work (GCW) improved significantly in both groups (1.86 vs 2.13 L/min/m2, P = .02, 1.73 vs 2.28 L/min/m2 P = .002 and 977 vs 1101 mm Hg.%, P = .003, 967 vs 1110 mm Hg.%, P = .002 for PMVR and OMT groups, respectively) whereas left ventricular (LV) end‐systolic volume index, LV ejection fraction, and global longitudinal strain were not different. Receiver operating characteristics in PMVR with LVEF ≤ 35% subgroup analysis demonstrated that global work index (GWI) had the best ability to identify patients with worse evolution (AUC = 0.882; P = .009), confirmed by univariable logistic regression, particularly for patients with GWI < 482 mm Hg.%. Conclusion Echocardiographic characteristics at 6‐month follow‐up are not different when compare PMVR and OMT for HF patients with severe FMR. A low global work index might be a tool for discouraging the implantation of clips for this indication.

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Transcatheter Treatment of Valvular Heart Disease

Davidson

2021

JAMA

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ImportanceMore than 40 million people are living with either mitral or aortic valve disease worldwide, and more than 180 000 heart valve replacement surgeries are performed each year in the US. Transcatheter valve repair has emerged as an important therapeutic option for patients who are candidates for heart valve replacement.ObservationsAll transcatheter valve therapies involve a multidisciplinary team of interventional cardiologists, cardiothoracic surgeons, radiologists, echocardiographers, nurses, and social workers, termed the heart team, to determine the optimal approach for managing each patient. Transcatheter aortic valve implantation (TAVI) is an aortic valve replacement procedure that is performed percutaneously and is currently approved for patients with severe, symptomatic aortic stenosis in all surgical risk categories. The TAVI procedure can be performed using a balloon-expandable or self-expanding valve. In a low-risk cohort of patients (PARTNER [Placement of Aortic Transcatheter Valves] 3 trial), the rates of death from any cause, stroke, or rehospitalization were 8.5% for patients receiving TAVI and 15.1% for patients undergoing surgical aortic valve replacement. Decision-making regarding therapy choice should be based on individual anatomy (including the number of leaflets, annular size, and peripheral arterial anatomy), comorbidities (including concomitant coronary artery disease and aortopathies), and patient preference guide. A mitral transcatheter edge-to-edge repair device is approved by the US Food and Drug Administration for high-risk patients with degenerative and functional mitral regurgitation that has excellent safety and efficacy in these populations. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, the annualized rate of all hospitalizations for heart failure was 35.8% among patients who underwent transcatheter edge-to-edge repair and received medical therapy compared with 67.9% among patients in the medical therapy alone group. Transcatheter tricuspid valve repair and replacement trials are ongoing and show promise for the treatment of patients with tricuspid regurgitation, which previously had limited therapeutic options. Multimodality imaging, which includes transthoracic echocardiography, transesophageal echocardiography, computed tomography, and intracardiac echocardiography, is important for preprocedural planning, device selection, and optimal outcomes.Conclusions and RelevanceApproximately 78 000 TAVI procedures and 10 000 transcatheter mitral valve repairs take place yearly in the US to treat patients with severe, symptomatic aortic stenosis and mitral regurgitation, respectively. Transcatheter valve therapies have expanded therapeutic options for patients, including for those who previously had no viable surgical options.

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Proportionate and Disproportionate Functional Mitral Regurgitation

Cited by 521 publications

References 33 publications

Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Transcatheter mitral valve repair with clip for treatment of secondary or functional mitral insufficiency. Literature review

Left ventricular function after correction of mitral regurgitation: Impact of the clipping approach

Transcatheter Treatment of Valvular Heart Disease

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