Quantitative Assessment of Severity of Mitral Regurgitation by Serial Echocardiography in a Multicenter Clinical Trial of Percutaneous Mitral Valve Repair

Foster, Elyse; Wasserman, Hal S.; Gray, William A.; Homma, Shunichi; Tullio, Marco R. Di; Rodriguez, L. Leonardo; Stewart, William J.; Whitlow, Patrick L.; Block, Peter C.; Martin, Ryan C.; Merlino, John; Herrmann, Howard C.; Wiegers, Susan E.; Silvestry, Frank E.; Hamilton, Andrew; Zunamon, Alan; Kraybill, Kimberly; Gerber, Ivor L.; Weeks, Sarah; Zhang, Yan; Feldman, Ted

doi:10.1016/j.amjcard.2007.06.066

Cited by 191 publications

(101 citation statements)

References 20 publications

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“…MR at baseline was graded according to American Society of Echocardiography guidelines. 16) After the procedure, MR grade was assessed by the technique reported by Foster, et al 17) Main exclusion criteria were severe clinical comorbidities, such as end-stage cancer or other severe diseases with a very unfavorable prognosis. Patients were excluded if the morphology of the mitral valve made percutaneous edge-to-edge mitral valve repair technically impossible or unlikely beyond the classical EVEREST criteria (ie, short or calcified posterior leaflet without the possibility of leaflet grasping or the beginnings of mitral stenosis).…”

Section: Methodsmentioning

confidence: 99%

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

et al. 2017

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SummaryMitraClip (MC) is an alternative therapeutic option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Most candidates for MC have severe heart failure (HF) with increased N-terminal pro-B-type natriuretic peptide (NT-pro BNP) levels. We sought to clarify the response of NT-pro BNP after MC and to identify the determinants of NT-pro BNP nonresponders. Among 136 consecutive patients successfully treated with MC, we excluded 20 patients due to low baseline NT-pro BNP levels and therefore examined 116 patients. NT-pro BNP responders were defined as patients whose NT-pro BNP levels decreased by > 30% at 6 months after MC. Mean NT-pro BNP levels significantly decreased from 6,117 pg/mL at baseline to 4,143 pg/mL at 6 months after MC (P < 0.001); 61 patients (53%) were responders. Diabetes mellitus (DM) (51% versus 25%; P = 0.003) and atrial fibrillation (67% versus 49%; P = 0.049) were more common in nonresponders. Baseline New York Heart Association (NYHA) class and NT-proBNP levels were higher in responders. Right ventricular systolic dysfunction (RVSD) defined as tricuspid annular plane systolic excursion (TAPSE) < 15 mm was more common in nonresponders (41% versus 18%; P = 0.008). Multivariable logistic regression analysis revealed that DM (odds ratio [OR], 2.966; P = 0.014), RVSD (OR, 3.948; P = 0.006), and baseline NT-proBNP > 5,000 pg/mL (OR, 0.204; P = 0.001) were independent determinants of nonresponders. All-cause death tended to be less common in responders to NT-pro BNP (20% versus 31%; P = 0.163). In conclusion, NT-pro BNP levels significantly decreased after MC. DM and RVSD were determinants of NT-pro BNP nonresponse after the MC procedure. (Int Heart J 2017; 58: 225-231)

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Section: Methodsmentioning

confidence: 99%

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

et al. 2017

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“…28 Despite the use of expert core laboratory facilities and a standardized guidelinesbased approach, 18,29 MR quantification can be challenging after MitraClip placement. It is possible that the small decrease in LV volumes seen even in patients with residual 3 to 4+ MR reflects a small decrease in regurgitant volume that is sufficient to reduce LV volumes without changing MR grade to 2+ or better.…”

Section: Limitationsmentioning

confidence: 99%

“…Details of MR grading pre-and post-MitraClip have been previously reported. 18 LV volumes and ejection fraction were measured using the biplane method of disks. LA volumes were measured by biplane method.…”

Section: Data Collectionmentioning

confidence: 99%

Relationship Between the Magnitude of Reduction in Mitral Regurgitation Severity and Left Ventricular and Left Atrial Reverse Remodeling After MitraClip Therapy

et al. 2013

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Background-MitraClip has been shown to reduce mitral regurgitation (MR) severity safely but to a lesser degree than surgery. No data exist on the magnitude of MR reduction necessary to reverse left ventricular (LV) and left atrial (LA) dilation in patients with severe MR. Therefore, an analysis was performed to evaluate the relationship between MR reduction and LV and LA volumes after MitraClip therapy. Methods and Results-A total of 801 patients treated with MitraClip and 80 patients treated surgically were included. All patients had severe (3-4+) MR. MR severity, LV volumes at end-diastole and end-systole, and LA volumes were measured at baseline, discharge, 30 days, 6 months, and 1 year by an independent echocardiographic core laboratory. A linear repeated measures model was developed to determine the relationship between MR severity and time of measurement postindex procedure on longitudinal LV and LA volumes. Separate models were fit for functional MR and degenerative MR. In both degenerative and functional MR, reduction in LV volumes at end-diastole was associated with degree of residual MR at 12 months (P<0.0001). LV volumes at end-systole was significantly reduced in functional MR but not degenerative MR. LA volumes were significantly related to reduction of MR severity in both groups. Conclusions-Reduction of LV volumes at end-diastole and LA volumes, but not LV volumes at end-systole in degenerative MR, is consistent with correction of volume overload from primary MR. Reduction of all 3 measurements in functional MR demonstrates reverse remodeling when MR severity is reduced to either 1+ or 2+ by MitraClip therapy. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00209274.

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“…6 In particular, severity of MR was assessed according to the technique previously described by Foster et al 7 Clinical and echocardiographic follow-up were scheduled at 6 weeks, 3 months, 6 months and 1 year thereafter.…”

Section: Medication and Follow-upmentioning

confidence: 99%

Real-World Experience of MitraClip for Treatment of Severe Mitral Regurgitation

Chan

She

Alegría-Barrero

et al. 2012

Circ J

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Quantitative Assessment of Severity of Mitral Regurgitation by Serial Echocardiography in a Multicenter Clinical Trial of Percutaneous Mitral Valve Repair

Cited by 191 publications

References 20 publications

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip

Relationship Between the Magnitude of Reduction in Mitral Regurgitation Severity and Left Ventricular and Left Atrial Reverse Remodeling After MitraClip Therapy

Real-World Experience of MitraClip for Treatment of Severe Mitral Regurgitation

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