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Catheter Cardiovasc Interv. 2019 May 1;93(6):1152-1160. doi: 10.1002/ccd.28147. Epub 2019 Feb 21.

Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography.

Author information

1
Greenberg Cardiology Division, Weill Cornell Medicine, New York, New York.
2
Division of Cardiology, Memorial Sloan Kettering Cancer Center, New York, New York.
3
Division of Cardiology, Columbia University Medical Center, New York, New York.
4
Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
5
Department of Bioengineering, University of California, Veterans Affairs Medical Center, San Francisco, California.

Abstract

OBJECTIVES:

To assess impact of left ventricular (LV) chamber remodeling on MitraClip (MClp) response.

BACKGROUND:

MitraClip is the sole percutaneous therapy approved for mitral regurgitation (MR) but response varies. LV dilation affects mitral coaptation; determinants of MClp response are uncertain.

METHODS:

LV and mitral geometry were quantified on pre- and post-procedure two-dimensional (2D) transthoracic echocardiography (TTE) and intra-procedural three-dimensional (3D) transesophageal echocardiography (TEE). Optimal MClp response was defined as ≤mild MR at early (1-6 month) follow-up.

RESULTS:

Sixty-seven degenerative MR patients underwent MClp: Whereas MR decreased ≥1 grade in 94%, 39% of patients had optimal response (≤mild MR). Responders had smaller pre-procedural LV end-diastolic volume (94 ± 24 vs. 109 ± 25 mL/m2 , p = 0.02), paralleling smaller annular diameter (3.1 ± 0.4 vs. 3.5 ± 0.5 cm, p = 0.002), and inter-papillary distance (2.2 ± 0.7 vs. 2.5 ± 0.6 cm, p = 0.04). 3D TEE-derived annular area correlated with 2D TTE (r = 0.59, p < 0.001) and was smaller among optimal responders (12.8 ± 2.1 cm2 vs. 16.8 ± 4.4 cm2 , p = 0.001). Both 2D and 3D mitral annular size yielded good diagnostic performance for optimal MClp response (AUC 0.73-0.84, p < 0.01). In multivariate analysis, sub-optimal MClp response was associated with LV end-diastolic diameter (OR 3.10 per-cm [1.26-7.62], p = 0.01) independent of LA size (1.10 per-cm2 [1.02-1.19], p = 0.01); substitution of mitral annular diameter for LV size yielded an independent association with MClp response (4.06 per-cm2 [1.03-15.96], p = 0.045).

CONCLUSIONS:

Among degenerative MR patients undergoing MClp, LV and mitral annular dilation augment risk for residual or recurrent MR, supporting the concept that MClp therapeutic response is linked to sub-valvular remodeling.

KEYWORDS:

TTE/TEE; imaging; mitral valve disease; percutaneous intervention; structural heart disease intervention

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