Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Gaemperli, Oliver; Biaggi, Patric; Gugelmann, Remo; Osranek, Martin; Schreuder, Jan J.; Bühler, Ines; Sürder, Daniel; Lüscher, Thomas F.; Felix, Carol; Béttex, Dominique; Grünenfelder, Jürg; Corti, Roberto

doi:10.1161/circulationaha.112.135061

Cited by 108 publications

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“…Patients were selected for the procedure according to both the current guidelines on valvular heart disease and the previously published guidelines. 1,10,11 The clinical patient data were obtained by chart review. All patients gave written informed consent for inclusion in a prospective MitraClip registry (MitraSwiss registry).…”

Section: Patient Populationmentioning

confidence: 99%

“…A pigtail catheter was placed into the left ventricle for measurement of the left ventricular end-diastolic pressure, the transmitral gradients (dPmean INV ), and systemic artery oxygen saturation as previously described. 10,11 The cardiac output and MVA were calculated using the Fick principle 18 and according to the Gorlin formula (MVA Gorlin ), respectively. …”

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confidence: 99%

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Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Biaggi

Felix

Gruner

et al. 2013

Circ: Cardiovascular Imaging

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Background-Quantification of the mitral valve area (MVA) is important to guide percutaneous mitral valve repair using the MitraClip system. However, little is known about how to best assess MVA in this specific situation. Methods and Results-Immediately before and after MitraClip implantation, transesophageal echocardiography data were acquired for MVA assessment by the pressure half-time method and by two 3D quantification methods (mitral valve quantification software and 3D quantification software). In addition, transmitral gradients by continuous-wave Doppler (dPmean CW ) were measured to indirectly assess MVA. Data are given as median (interquartile range). Thirty-three patients (39% women) with a median age of 77.1 years (12.4 years) were studied. Before intervention, the median MVAs by the pressure half-time method, mitral valve quantification software, and 3D quantification software were 4.4 cm 2 (2.0 cm 2 ), 4.7 cm 2 (2.4 cm 2 ), and 6.2 cm 2 (2.4 cm 2 ), respectively (P<0.001). After intervention, MVA was reduced to 1.9 cm 2 (0.7 cm 2 ), 2.1 cm 2 (1.1 cm 2 ), and 2.8 cm 2 (1.1 cm 2 ), respectively (P=0.001). The median values for dPmean CW before and after intervention were 1.0 mm Hg (1.0 mm Hg) and 3.0 mm Hg (3.0 mm Hg; P<0.001), respectively. At discharge, the median dPmean CW was 4.0 mm Hg (3.0 mm Hg). In multivariate regression analyses including body surface area, the 3 different MVA methods, and dPmean CW , a post-dPmean CW ≥5 mm Hg was the best independent predictor of an elevated transmitral gradient at discharge. Methods Patient PopulationWe included consecutive patients undergoing percutaneous MVR using the MitraClip system at the University Hospital Zurich, Zurich, Switzerland. Patients were selected for the procedure according to both the current guidelines on valvular heart disease and the previously published guidelines. 1,10,11 The clinical patient data were obtained by chart review. All patients gave written informed consent for inclusion in a prospective MitraClip registry (MitraSwiss registry). The protocol of the MitraSwiss registry was approved by the local institutional review board. EchocardiographyTEE was performed using a Philips iE33 platform and an X7-2t real-time 3D TEE probe (Philips Medical Systems, Andover, MA). A 2D TTE was performed in all patients at the time of discharge. All measurements were performed according to the guidelines.12 MR was graded mild (1+), moderate (2+), moderate to severe (3+), and severe (4+).11 Mitral stenosis was defined by an MVA <2 cm 2 : mild, by 1.5 to 1.99 cm 2 ; moderate, by 1.0 to 1.49 cm 2 ; and severe, by <1 cm 2 . In addition, a mean transvalvular gradient ≥5 mm Hg was considered stenosed mitral valve. 4,13 Immediately before the start of the procedure and after the last clip was placed, continuous-wave (CW) Doppler of mitral valve inflow was used for the assessment of the mean gradient across the mitral valve (dPmean CW ) and of MVA by PHT (MVA PHT ). 9 The beam of the CW Doppler was located in the center of the largest orifice after ...

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Section: Patient Populationmentioning

confidence: 99%

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confidence: 99%

Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Biaggi

Felix

Gruner

et al. 2013

Circ: Cardiovascular Imaging

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“…Cardiac output or FSV was reported to increase by 10% to 30% of baseline value after MitraClip implantation. 9,18,19 In this study, successful MitraClip procedure increased FSV at discharge by a median of 13% from baseline. However, it was unknown whether the FSV response affects the clinical outcomes after MitraClip implantation.…”

Section: Discussionmentioning

confidence: 54%

“…The previous study demonstrated that a degree of immediate increase of cardiac output was significantly less in patients with functional MR compared with degenerative MR after successful MitraClip implantation. 19 In cases with functional MR, because of underlying myocardial systolic dysfunction, LV contractile reserve may be insufficient to immediately increase FSV even after successful reduction of MR by MitraClip.…”

Section: Discussionmentioning

confidence: 99%

Impact of Forward Stroke Volume Response on Clinical and Structural Outcomes After Percutaneous Mitral Valve Repair With MitraClip

Kubo

Nakamura

Shiota

et al. 2017

Circ: Cardiovascular Interventions

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Background-An increase of systolic forward flow was frequently observed after successful MitraClip implantation in patients with significant mitral regurgitation. However, the impact of systolic forward flow improvement on postMitraClip outcomes remains unknown. Methods and Results-Study population included 160 patients who underwent successful MitraClip implantation. The systolic forward flow was noninvasively calculated as the forward stroke volume (FSV) at baseline before the MitraClip procedure and before discharge with pulse-wave Doppler using transthoracic echocardiography. The optimal threshold of discharge/baseline FSV ratio for 3-year all-cause death was assessed. The best cutoff ratio was 1.09 (9% FSV increase from baseline, P=0.006). The FSV responders were defined as those with >9% increase of FSV from baseline (n=93). From discharge to 12-month follow-up, a significant reduction of LV end-diastolic and end-systolic volumes was observed in the responders, whereas no significant change was observed in the nonresponders. Furthermore, the proportion of New York Heart Association functional class III/IV was significantly lower in the responders at 12 months (2.9% versus 14.6%; P=0.03). Among patients with estimated glomerular filtration rate <60 mL/min per 1.73 m2, estimated glomerular filtration rate was significantly improved at 12 months only in the responders. All-cause mortality at 3 years was significantly lower in the responders than in the nonresponders (17.6% versus 42.3%; P=0.002). Multivariable logistic analysis identified higher baseline FSV, less mitral regurgitation severity, and functional mitral regurgitation as independent predictors of the nonresponders. Conclusions-FSV increase after MitraClip implantation was associated with more favorable clinical and anatomic outcomes. Severity and pathogenesis of mitral regurgitation and pre-MitraClip FSV predicted postprocedural FSV response. (Circ Cardiovasc Interv. 2017;10:e004909.

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“…Successful PMVR can improve cardiac haemodynamics1, 2 and quality of life 3. However, mortality remains substantial after PMVR, and re‐hospitalizations for heart failure occur in up to one‐fourth of patients within 1 year 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

et al. 2017

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A patient presented with symptoms of decompensated heart failure 2 months after percutaneous mitral valve (MV) repair. Echocardiography demonstrated impaired left ventricular function with elevated MV pressure gradients and pulmonary pressures during rapid atrial fibrillation. Heart rate control was achieved by implantation of a biventricular pacemaker with subsequent His‐bundle ablation because atrial fibrillation was refractory to medical treatment. During biventricular pacing at different rates (50–110 b.p.m.), heart rate correlated positively with both MV mean pressure gradient and global longitudinal strain and negatively with stroke volume. MV pressure gradients directly translated into elevated pulmonary pressures. Thus, rate control and biventricular pacing improved cardiac haemodynamics.

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Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Cited by 108 publications

References 50 publications

Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Assessment of Mitral Valve Area During Percutaneous Mitral Valve Repair Using the MitraClip System

Impact of Forward Stroke Volume Response on Clinical and Structural Outcomes After Percutaneous Mitral Valve Repair With MitraClip

Mitral valve pressure gradient after percutaneous mitral valve repair: every beat counts

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