Preprocedural transthoracic echocardiography for predicting outcomes of transcatheter edge-to-edge repair for chronic primary mitral regurgitation

Alon Shechter; Vivek Patel; Danon Kaewkes; Mirae Lee; Gloria J Hong; Ofir Koren; Tarun Chakravarty; Keita Koseki; Takashi Nagasaka; Sabah Skaf; Moody Makar; Raj R Makkar; Robert J Siegel

doi:10.1016/j.rec.2023.12.001

Preprocedural transthoracic echocardiography for predicting outcomes of transcatheter edge-to-edge repair for chronic primary mitral regurgitation

Rev Esp Cardiol (Engl Ed). 2023 Dec 22:S1885-5857(23)00345-6. doi: 10.1016/j.rec.2023.12.001. Online ahead of print.

[Article in English, Spanish]

Authors

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: alonshechter@gmail.com.
² Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States.
³ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
⁴ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea.
⁵ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, United States.
⁶ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
⁷ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
⁸ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, United States; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, United States. Electronic address: Robert.Siegel@cshs.org.

PMID: 38142937
DOI: 10.1016/j.rec.2023.12.001

Abstract

Introduction and objectives: Limited data exist on the prognostic usefulness of transthoracic echocardiography preceding MitraClip for chronic primary mitral regurgitation (MR). We evaluated the predictive ability of transthoracic echocardiography in this setting.

Methods: A total of 410 patients (median age, 83 years, 60.7% males) were included in the study. The primary outcome was the 1-year composite of all-cause mortality or heart failure hospitalization. Secondary endpoints encompassed individual elements of the primary outcome, the persistence of significant functional impairment or above-moderate MR at 1 year, and above-mild MR at 1-month.

Results: Left ventricular end-systolic diameter index of ≥ 2.1cm/m², corresponding to the cohort's 4th quartile (HR, 2.44; 95%CI, 1.09-4.68; P=.022). Concurrently, higher left atrial volume index (LAVi) and a mid-diastolic medial-lateral mitral annular diameter (MAD) equal to or above the cohort's median of 32.2mm were linked to a higher probability of death and heart failure hospitalization, respectively. LAVi of ≥ 60mL/m², above-mild mitral annular calcification, and above-moderate tricuspid regurgitation conferred higher odds of functional class III-IV or above-moderate MR persistence. All variables except LAVi and MAD, as well as indexed mid-diastolic medial-lateral MAD of ≥ 20.2mm/m² and mitral effective regurgitant orifice area of ≥ 0.40 cm², were associated with greater-than-mild MR at 1 month.

Conclusions: Preprocedural increased indexed left heart dimensions, mainly left ventricular end-systolic diameter index, MAD, mitral annular calcification, mitral effective regurgitant orifice area, and tricuspid regurgitation mark a less favorable course post-MitraClip for chronic primary MR.

Keywords: Ecocardiografía transtorácica; Insuficiencia mitral; MitraClip; Mitral regurgitation; Mitral transcatheter edge-to-edge repair; Pronóstico; Reparación mitral percutánea de borde a borde; Reparación percutánea de la válvula mitral; Transcatheter mitral valve repair; Transthoracic echocardiography.