Elsevier

The American Journal of Cardiology

Volume 182, 1 November 2022, Pages 69-76
The American Journal of Cardiology

Impact of Left Ventricular Global Longitudinal Strain on Outcomes After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

https://doi.org/10.1016/j.amjcard.2022.07.023Get rights and content

Assessment of left ventricular (LV) systolic function is essential in patient selection for transcatheter edge-to-edge repair (TEER) in secondary mitral regurgitation (MR). Although LV ejection fraction (EF) is mostly used for assessing LV function, it represents the change of LV chamber size, but not myocardial contractility. LV global longitudinal strain (GLS) provides an alternative to assess LV systolic function in patients with secondary MR. This study included 380 patients with secondary MR (mean age 71.0 ± 13.0 years; 61.1% male) who underwent TEER. Patients were dichotomized based on baseline LV GLS (more impaired GLS [<7.0%] vs less impaired GLS [≥7%]) based on existing literature. The primary outcome was all-cause mortality, whereas the secondary outcome was the composite end point of all-cause mortality and heart failure hospitalization. The mean LV GLS was 8.1 ± 3.8%, and 162 patients had GLS <7%. Patients with more impaired GLS (<7%) were more likely to be male (68.5% vs 55.5%; p = 0.01) and have larger LV end-diastolic volume (110.5 ± 36.5 ml/m2 vs 92.9 ± 34.3 ml/m2; p <0.001) and lower LVEF (22.2 ± 8.9% vs 36.4 ± 14.5%; p <0.001) than those with less impaired GLS (≥7%). The number of clips used and residual MR were similar between the 2 groups. Patients with more impaired LV GLS (<7%) had significantly higher 2-year event rates of the primary outcome (38.2% vs 25.9%; log-rank p = 0.003) and the secondary outcome (52.5% vs 36.3%; log-rank p <0.001). Multivariate analysis showed that LV GLS (<7%) was independently associated with the primary outcome (hazard ratio 1.65, 95% confidence interval 1.16 to 2.34, p = 0.005) and the secondary outcome (hazard ratio 1.54, 95% confidence interval 1.08 to 2.20, p = 0.016) whereas such associations were not observed with LVEF. In conclusion, LV GLS (<7%) was independently associated with a higher risk of adverse events in patients with secondary MR who underwent TEER.

Section snippets

Methods

Consecutive patients with moderate-to-severe and severe secondary MR who underwent TEER were included in this analysis. We excluded: (1) patients who had primary or mixed etiology MR; (2) patients with an aborted TEER procedure; (3) patients who were lost to follow-up; (4) patients whose baseline echocardiographic images were not available or had suboptimal quality for LV GLS assessment. Baseline demographic and clinical data and echocardiographic measurements were collected using the hospital

Results

A total of 447 patients with secondary MR who underwent TEER with the MitraClip device at Cedars-Sinai Medical Center from March 2016 to August 2019 were included. After excluding 67 patients (12 patients with aborted procedures, 15 lost to follow-up, and 40 patients with baseline echocardiographic images not available or suboptimal quality for LV GLS measurement), 380 patients were included in this analysis. The mean LV GLS measurement was 8.1 ± 3.8,% with excellent inter-observer and

Discussion

This is the first large study that evaluated the prognostic implication of LV GLS in patients who underwent TEER for secondary MR. Our principal findings are as follows: (1) patients with more impaired LV GLS (< 7%) had larger LV volumes and lower LVEF as compared with those with less impaired LV GLS despite no significant differences in MR grade, pulmonary artery pressure, and tricuspid regurgitation; (2) more impaired LV GLS (< 7%) was independently associated with all-cause mortality and the

Disclosures

Dr. Makkar reported receiving research grants, consulting, and speaker fees from Edwards Lifesciences, Abbott, Medtronic, and Boston Scientific. Dr. Bax reported receiving speaker fees from Abbott Vascular and Edwards Lifesciences.

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    • The Department of Cardiology of the Leiden University Medical Center receives unrestricted grants from Biotronik (XX, X), Medtronic (XX, X), General Electric (XX, X), Boston Scientific Corporation (XX, X), Abbott Medical (XX, X), and Edwards Lifesciences (XX, X).

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