Effect of Percutaneous Edge-to-Edge Repair on Mitral Valve Area and Its Association With Pulmonary Hypertension and Outcomes

Hiroto Utsunomiya, Yuji Itabashi, Sayuki Kobayashi, Florian Rader, Asma Hussaini, Moody Makar, Alfredo Trento, Robert J. Siegel, Saibal Kar, Takahiro Shiota

研究成果: Article査読

16 被引用数 (Scopus)

抄録

Percutaneous edge-to-edge repair using the MitraClip system causes reduction in mitral valve area (MVA). However, its clinical impact is not fully elucidated. This study assessed the impact of postprocedural MVA reduction on pulmonary hypertension and outcomes. A total of 92 patients with grades 3 to 4 + mitral regurgitation (MR) who underwent MitraClip therapy were retrospectively reviewed. Using intraprocedural, 3-dimensional transesophageal echocardiography, postprocedural MVA was obtained by 2 optimized planes through the medial and lateral orifices of the repaired valve. MVA was reduced by 60.1% immediately after MitraClip procedure (p <0.001). Postprocedural MVA correlated moderately with mean transmitral pressure gradient (TMPG) in the majority of patients (r = −0.56, p <0.001), but discordance of MVA and TMPG was observed in 40% of patients. In multivariable linear regression analysis, postprocedural MVA ≤1.94 cm2 was independently associated with a blunted decrease in systolic pulmonary artery pressure at 1-month follow-up (β-estimate −4.63, 95% confidence interval −9.71 to −0.15, p = 0.042). Postprocedural MVA ≤1.94 cm2 was an independent predictor of all-cause mortality and heart failure hospitalization after MitraClip (hazard ratio 4.28, 95% confidence interval 1.56 to 11.7, p = 0.005) even after adjustment for age, gender, atrial fibrillation, cause of MR, left ventricular systolic function, pre-existing pulmonary hypertension, and residual MR. After further adjustment for TMPG ≥5 mm Hg, postprocedural MVA ≤1.94 cm2 remained predictive for adverse outcomes (p = 0.048). In conclusion, the intraprocedural assessment of MVA by 3-dimensional transesophageal echocardiography can predict hemodynamic response and postprocedural prognosis after MitraClip therapy.

本文言語English
ページ(範囲)662-669
ページ数8
ジャーナルAmerican Journal of Cardiology
120
4
DOI
出版ステータスPublished - 2017 8月 15
外部発表はい

ASJC Scopus subject areas

  • 循環器および心血管医学

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