Abstract
ObjectiveTo assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI).MethodsIn this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months. Patients having a significant reduction of at least 30% in VC were defined as good responders (GR) and the remaining patients were defined as poor responders (PR).ResultsAfter 6 months of TAVI, 27 (45%) patients were GR and 33 (55%) were PR. There was a significant decrease in 3DE-derived mitral annular diameter and area (P = 0.001), mitral valve tenting area (TA) (P = 0.05), and mitral papillary muscle dyssynchrony index (DSI) (P = 0.05) in the GR group. 3DE-derived LVESV (P = 0.016), LV mass (P = 0.001) and LV DSI, (P = 0.001) were also improved 6 months after TAVI. In addition, valvulo-arterial impedance (ZVA) was significantly higher at baseline in patients with PR (P = 0.028). 3DE-derived mitral annular area (β: 0.47, P = 0.04), mitral papillary DSI (β: −0.65, P = 0.012) and ZVA (β: 0.45, P = 0.028) were the strongest independent parameters that could predict the reduction of functional MR after TAVI.ConclusionGR patients demonstrate more regression in mitral annulus area and diameter after significant decrease in high LVEDP and trans-aortic gradients with TAVI. PR patients appear to have increased baseline ZVA, mitral valve tenting and restriction in mitral valve coaptation. These factors are important for predicting the impact of TAVI on pre-existing MR.
Highlights
Mitral regurgitation (MR) is present in up to twothird of patients with aortic stenosis (AS) (1)
Of the total number of patients, 60 (mean age 84.4 ± 5.97 years and 41.6% patients were women) who had at least a mild degree of MR at baseline echocardiography were included in the study
We have demonstrated a significant improvement in functional MR and left ventricular (LV) geometry after trans-catheter aortic valve implantation (TAVI)
Summary
Mitral regurgitation (MR) is present in up to twothird of patients with aortic stenosis (AS) (1). It may be secondary to AS (functional) or due to intrinsic pathology of the mitral apparatus itself (organic) (2). Www.echorespract.com Published by Bioscientifica Ltd. The issue of how to address MR during a surgical or interventional procedure for AS continues to be a matter of debate. The issue of how to address MR during a surgical or interventional procedure for AS continues to be a matter of debate This is because limited data are currently available to support clinical decision-making. Residual MR in patients who undergo SAVR is important because it is clearly associated with a worse long-term prognosis. It is important to predict MR improvement after SAVR
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