Clinical InvestigationValvular Heart DiseaseRecurrence of Functional Versus Organic Mitral Regurgitation After Transcatheter Mitral Valve Repair: Implications from Three-Dimensional Echocardiographic Analysis of Mitral Valve Geometry and Left Ventricular Dilation for a Point of No Return
Graphical Abstract
Section snippets
Study Design and Objectives
Of 133 consecutive patients who underwent TMVR using the MitraClip (Abbott Laboratories, Abbott Park, IL) for the treatment of FMR and OMR between March 2009 and February 2014, 61 patients (45 with FMR, 16 with OMR) who had complete 3D echocardiographic data sets acquired within 7 days before TMVR and at 6-month follow-up were retrospectively analyzed. The percentages of patients with FMR (73.8%) and OMR (26.2%) in our study group were similar to the ratio in the total group of 133 consecutive
Results
Intraprocedural MR grading of color Doppler jet size before and after TMVR showed satisfactory MR reduction in all 61 patients (grade 2.75 vs 1.53, with MR reduction to grade < 2 in 38 patients and from grade 3 to grade 2 in 23 patients) independent of MR mechanism (FMR, 2.69 vs 1.52; OMR, 2.93 vs 1.53; Table 1).
Discussion
To the best of our knowledge, this is the first study to comprehensively analyze the association of 3D echocardiographic MV geometry in concert with LV size and function on MR recurrence and MV remodeling after TMVR and the differences between patients with FMR and those with OMR. In all, 34% of patients (21 of 61) had MR recurrence at follow-up, which is in line with the reported 34% of patients (26 of 76) with MR > 2+ at 1 year after TMVR in the EVEREST study,4 but the rates were higher
Conclusion
Comprehensive 3D echocardiographic analysis of MV geometry and two-dimensional echocardiographic LV size and function revealed MR recurrence in patients with FMR to be strongly associated with advanced LV dilation and MV tethering at baseline, with LVEDVi being the strongest independent determinant. In patients with OMR, however, no significant determinants of MR recurrence could be identified despite associations with progressive MV annular dilation, leaflet enlargement, and prolapse size.
Acknowledgments
We wish to acknowledge Mirjam Frank, MD, and Börge Schmidt, MD, PhD, Institute of Medical Informatics, Biometry and Epidemiology of University Essen, Germany, for their support in statistical analyses.
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Conflicts of Interest: The authors declare that there are no conflicts of interest or funding for this article.