Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement: Hemodynamic analysis using echocardiography

Yuji Itabashi, Kentaro Shibayama, Hirotsugu Mihara, Hiroto Utsunomiya, Javier Berdejo, Reza Arsanjani, Robert Siegel, Tarun Chakravarty, Hasan Jilaihawi, Raj R. Makkar, Takahiro Shiota

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Reduction in mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) has previously been reported. However, the hemodynamic effects of TAVR in patients with MR have not been previously evaluated. Methods We analyzed 571 patients who underwent TAVR from December 2010 to December 2013. We studied 20 patients with moderate or severe preprocedural functional mitral regurgitation (FMR) who also had a follow-up transthoracic echocardiography (TTE) examination between 90 and 360 days (median 213 days) after TAVR (Significant FMR Group). We also studied age- and gender-matched 20 patients with mild or lesser MR (Nonsignificant MR Group). Left ventricular functional measurements were assessed using echocardiography before and after TAVR. Left ventricular outflow tract stroke volume measurements using pulsed-wave Doppler (SVLVOT) were calculated as a representative of systolic forward flow, and stroke volume by the Simpson's method (SVSimpson) was calculated as a parameter of degree of LV contraction. Results MR grade improved in 22 of 40 patients after TAVR. In both groups, BNP level decreased, left ventricular ejection fraction increased, and SVLVOT increased after TAVR. SVSimpson increased in the Nonsignificant MR Group and remained unchanged in the Significant FMR Group. Vena contracta width of MR (MRVC) decreased in the Significant FMR Group. Using multivariable analysis in the Significant FMR Group, the increase in SVLVOT significantly correlated with the decrease in MRVC (P < 0.05). Conclusions SVLVOT increased significantly after TAVR in patients with FMR. In these patients, increase in SVLVOT after TAVR was associated with decrease in severity of MR.

Original languageEnglish
Pages (from-to)1621-1627
Number of pages7
JournalEchocardiography
Volume32
Issue number11
DOIs
Publication statusPublished - 2015 Nov 1
Externally publishedYes

Fingerprint

Mitral Valve Insufficiency
Echocardiography
Hemodynamics
Stroke Volume
Transcatheter Aortic Valve Replacement

Keywords

  • cardiac output
  • mitral regurgitation
  • stroke volume
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Medicine(all)
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement : Hemodynamic analysis using echocardiography. / Itabashi, Yuji; Shibayama, Kentaro; Mihara, Hirotsugu; Utsunomiya, Hiroto; Berdejo, Javier; Arsanjani, Reza; Siegel, Robert; Chakravarty, Tarun; Jilaihawi, Hasan; Makkar, Raj R.; Shiota, Takahiro.

In: Echocardiography, Vol. 32, No. 11, 01.11.2015, p. 1621-1627.

Research output: Contribution to journalArticle

Itabashi, Yuji ; Shibayama, Kentaro ; Mihara, Hirotsugu ; Utsunomiya, Hiroto ; Berdejo, Javier ; Arsanjani, Reza ; Siegel, Robert ; Chakravarty, Tarun ; Jilaihawi, Hasan ; Makkar, Raj R. ; Shiota, Takahiro. / Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement : Hemodynamic analysis using echocardiography. In: Echocardiography. 2015 ; Vol. 32, No. 11. pp. 1621-1627.
@article{25ef5f16117b4a67b8d6ba5a2f7f4fd7,
title = "Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement: Hemodynamic analysis using echocardiography",
abstract = "Background Reduction in mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) has previously been reported. However, the hemodynamic effects of TAVR in patients with MR have not been previously evaluated. Methods We analyzed 571 patients who underwent TAVR from December 2010 to December 2013. We studied 20 patients with moderate or severe preprocedural functional mitral regurgitation (FMR) who also had a follow-up transthoracic echocardiography (TTE) examination between 90 and 360 days (median 213 days) after TAVR (Significant FMR Group). We also studied age- and gender-matched 20 patients with mild or lesser MR (Nonsignificant MR Group). Left ventricular functional measurements were assessed using echocardiography before and after TAVR. Left ventricular outflow tract stroke volume measurements using pulsed-wave Doppler (SVLVOT) were calculated as a representative of systolic forward flow, and stroke volume by the Simpson's method (SVSimpson) was calculated as a parameter of degree of LV contraction. Results MR grade improved in 22 of 40 patients after TAVR. In both groups, BNP level decreased, left ventricular ejection fraction increased, and SVLVOT increased after TAVR. SVSimpson increased in the Nonsignificant MR Group and remained unchanged in the Significant FMR Group. Vena contracta width of MR (MRVC) decreased in the Significant FMR Group. Using multivariable analysis in the Significant FMR Group, the increase in SVLVOT significantly correlated with the decrease in MRVC (P < 0.05). Conclusions SVLVOT increased significantly after TAVR in patients with FMR. In these patients, increase in SVLVOT after TAVR was associated with decrease in severity of MR.",
keywords = "cardiac output, mitral regurgitation, stroke volume, transcatheter aortic valve replacement",
author = "Yuji Itabashi and Kentaro Shibayama and Hirotsugu Mihara and Hiroto Utsunomiya and Javier Berdejo and Reza Arsanjani and Robert Siegel and Tarun Chakravarty and Hasan Jilaihawi and Makkar, {Raj R.} and Takahiro Shiota",
year = "2015",
month = "11",
day = "1",
doi = "10.1111/echo.12936",
language = "English",
volume = "32",
pages = "1621--1627",
journal = "Echocardiography",
issn = "0742-2822",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Significant reduction in mitral regurgitation volume is the main contributor for increase in systolic forward flow in patients with functional mitral regurgitation after transcatheter aortic valve replacement

T2 - Hemodynamic analysis using echocardiography

AU - Itabashi, Yuji

AU - Shibayama, Kentaro

AU - Mihara, Hirotsugu

AU - Utsunomiya, Hiroto

AU - Berdejo, Javier

AU - Arsanjani, Reza

AU - Siegel, Robert

AU - Chakravarty, Tarun

AU - Jilaihawi, Hasan

AU - Makkar, Raj R.

AU - Shiota, Takahiro

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Background Reduction in mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) has previously been reported. However, the hemodynamic effects of TAVR in patients with MR have not been previously evaluated. Methods We analyzed 571 patients who underwent TAVR from December 2010 to December 2013. We studied 20 patients with moderate or severe preprocedural functional mitral regurgitation (FMR) who also had a follow-up transthoracic echocardiography (TTE) examination between 90 and 360 days (median 213 days) after TAVR (Significant FMR Group). We also studied age- and gender-matched 20 patients with mild or lesser MR (Nonsignificant MR Group). Left ventricular functional measurements were assessed using echocardiography before and after TAVR. Left ventricular outflow tract stroke volume measurements using pulsed-wave Doppler (SVLVOT) were calculated as a representative of systolic forward flow, and stroke volume by the Simpson's method (SVSimpson) was calculated as a parameter of degree of LV contraction. Results MR grade improved in 22 of 40 patients after TAVR. In both groups, BNP level decreased, left ventricular ejection fraction increased, and SVLVOT increased after TAVR. SVSimpson increased in the Nonsignificant MR Group and remained unchanged in the Significant FMR Group. Vena contracta width of MR (MRVC) decreased in the Significant FMR Group. Using multivariable analysis in the Significant FMR Group, the increase in SVLVOT significantly correlated with the decrease in MRVC (P < 0.05). Conclusions SVLVOT increased significantly after TAVR in patients with FMR. In these patients, increase in SVLVOT after TAVR was associated with decrease in severity of MR.

AB - Background Reduction in mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR) has previously been reported. However, the hemodynamic effects of TAVR in patients with MR have not been previously evaluated. Methods We analyzed 571 patients who underwent TAVR from December 2010 to December 2013. We studied 20 patients with moderate or severe preprocedural functional mitral regurgitation (FMR) who also had a follow-up transthoracic echocardiography (TTE) examination between 90 and 360 days (median 213 days) after TAVR (Significant FMR Group). We also studied age- and gender-matched 20 patients with mild or lesser MR (Nonsignificant MR Group). Left ventricular functional measurements were assessed using echocardiography before and after TAVR. Left ventricular outflow tract stroke volume measurements using pulsed-wave Doppler (SVLVOT) were calculated as a representative of systolic forward flow, and stroke volume by the Simpson's method (SVSimpson) was calculated as a parameter of degree of LV contraction. Results MR grade improved in 22 of 40 patients after TAVR. In both groups, BNP level decreased, left ventricular ejection fraction increased, and SVLVOT increased after TAVR. SVSimpson increased in the Nonsignificant MR Group and remained unchanged in the Significant FMR Group. Vena contracta width of MR (MRVC) decreased in the Significant FMR Group. Using multivariable analysis in the Significant FMR Group, the increase in SVLVOT significantly correlated with the decrease in MRVC (P < 0.05). Conclusions SVLVOT increased significantly after TAVR in patients with FMR. In these patients, increase in SVLVOT after TAVR was associated with decrease in severity of MR.

KW - cardiac output

KW - mitral regurgitation

KW - stroke volume

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=84946207557&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946207557&partnerID=8YFLogxK

U2 - 10.1111/echo.12936

DO - 10.1111/echo.12936

M3 - Article

C2 - 25817306

AN - SCOPUS:84946207557

VL - 32

SP - 1621

EP - 1627

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 11

ER -