Send to

Choose Destination
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

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



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


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.


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.


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).


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.


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

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center