Abstract
BackgroundTranscatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip® therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients.MethodsTMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip® implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software. Patients underwent clinical and echocardiographic evaluation at baseline and after 6 months. At follow-up, the patients were allocated into two groups according to their improvement in New York Heart Association (NYHA) functional class: a Low Responder group with ΔNYHA <1.5 (n = 25); and a High Responder group with ΔNYHA ≥1.5 (n = 20).ResultsAt 6-month follow-up, data analysis revealed that while mitral regurgitation was reduced significantly in both groups, only the High Responder group had experienced significant downsizing of the 3D circumference (137 ± 14 mm to 126 ± 13 mm; p < 0.01) and the anterior-to-posterior diameter (33 ± 5 mm to 29 ± 4 mm; p < 0.01) of the mitral annulus during the intervention. Furthermore, only the High Responder group with reverse annular remodeling as shown had substantial advances in quality of life (Minnesota living with heart failure questionnaire: 55 ± 10 to 34 ± 14 points; p < 0.01) and functional status (6-min walk distance: 290 ± 104 m to 462 ± 111 m; p = 0.07).ConclusionOur study demonstrates that instantaneous left ventricular annular remodeling during MitraClip® implantation is associated with improved clinical outcome of heart failure patients with functional mitral regurgitation.Trial registration The study was approved by the local ethics committee (Study Number 4497R, Registration ID: 2013121585). Trial registration: NCT02033811 Retrospectively registered January 9, 2014.
Highlights
Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR)
There is evidence from a recent study suggesting that clinical response to TMVR in patients with FMR is influenced by the immediate reduction of mitral regurgitation severity alone, and by effects of the M itraClip® on mitral valve geometry leading to acute downsizing of the mitral annulus during the procedure [10]
Patient characteristics In this study, symptomatic heart failure patients with FMR considered inoperable according to a previous heart team decision, New York Heart Association (NYHA) class II–IV, and an ejection fraction
Summary
Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). There is evidence from a recent study suggesting that clinical response to TMVR in patients with FMR is influenced by the immediate reduction of mitral regurgitation severity alone, and by effects of the M itraClip® on mitral valve geometry leading to acute downsizing of the mitral annulus during the procedure [10]. This observation is supported by the results of the recent TITAN II trial which could demonstrate that percutaneous mitral annuloplasty using the carillon device leads to clinical improvement in patients with FMR without using an edge-to-edge technology [11].
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