Presence Of Mitral Regurgitation Research Articles

Peak Early Diastolic Transmitral Velocity As A Surrogate Marker Of Short-Term Atrial Fibrillation Recurrence After Electrical Cardioversion.

The aim of this study was to assess if peak early diastolic transmitral velocity (E-wave) can be used as a surrogate marker of short-term atrial fibrillation (AF) recurrence. We prospectively studied 57 consecutive patients who underwent electrical cardioversion (ECV) for AF and successfully converted to sinus rhythm. N-terminal brain natriuretic peptide levels (BNP) before and after ECV was measured in all patients. The follow-up included physical examination and a 12-lead electrocardiogram 14 days and one month after the ECV. In 42.1% patients AF recurred during one-month follow-up period. Gender, presence of mitral regurgitation, treatment with angiotensin II receptor blocker and left atrium diameter independently influenced E-wave velocity before ECV. E-wave velocity fell immediately after successful ECV (94.0±27 cm/s vs 79.7±23 cm/s, P<0.0001). E-wave velocity before ECV>94 cm/s and E-wave velocity after ECV >80 cm/s were predictors of one-month AF recurrence [(Hazard Ratio) HR=3.62 with 95% CI=1.49-8.78 and HR=3.76 with 95% CI=1.40-10.10, respectively]. E-wave velocity before and E-wave velocity after ECV remained predictors of AF recurrence but only in non-hypertensive patients (HR=1.01 with 95% C.I=1.01-1.03 and HR=1.03 with 95% C.I=1.01-1.06, respectively). Similarly, BNP levels before and after ECV were associated with an increased the risk of AF recurrence (HR=1.14 with 95% C.I 1.01-1.28 and HR= 1.16 with 95% C.I 1.03- 1.31, respectively). The addition of BNP levels to E-wave velocity before ECV appeared to have incremental value on short-term AF recurrence but at a marginally statistical significance (LR chi2=3.28, p=0.07). E-wave velocity before and after ECV appears to be a marker of short-term recurrence of AF.

Improvement of Mitral Regurgitation after Transapical Transcatheter Aortic Valve Bioprosthesis Implantation

Implantation of transcatheter aortic bioprosthesis has become a procedure with increasingly relevance in medical practice for the treatment of aortic stenosis, especially in patients with high or prohibitive surgical risk for traditional surgery. The presence of mitral regurgitation (MR) may be associated with increased morbidity and mortality, however, some studies have shown reduction in the degree of regurgitation of this valve after treatment of the aortic valve.

Abstract 10765: Dilated and Tilted Mitral Annulus by Left Atrial Dilation May Cause Mitral Regurgitation in Nonvalvular Atrial Fibrillation

Background: Although mitral annular dilation has been considered to be the primary mechanism of mitral regurgitation (MR) in patients with nonvalvular atrial fibrillation (AF), whether a stretched mitral annulus is sufficient to cause significant MR remains controversial. The aim of this study was to clarify it. Methods: The presence of MR and left atrial dimension (LAD) were evaluated by echocardiography. Cardiac magnetic resonance imaging was performed in patients with AF and MR (AF-MR; n=23) or without MR (AF-noMR; n=56) and in controls with normal sinus rhythm (n=130). Using 4-chamber view, we quantified the end-systolic septolateral mitral annular diameter (MAD), angle (Angle) between the mitral annulus and the perpendicular line of the long axis of the left ventricle passing through the base of the anterior leaflet (Line), and the distance (Distance) between the mitral leaflets coaptation point and the Line (Figure). Results: LAD was significantly increased in AF-MR compared to AF-noMR and controls (50±9 mm, 41±7 mm, 36±5 mm, respectively, AF-MR vs. AF-noMR, P&lt;0.001, AF-MR vs. controls, P&lt;0.001). MAD, Angle and Distance were significantly increased in AF-MR compared to AF-noMR and controls (Figure). CONCLUSIONS: In concert with mitral annular dilation, tilted mitral annulus by left atrial dilatation may cause incomplete coaptation of the mitral leaflets resulting in the development of MR in nonvalvular AF.

Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.

Atrial fibrillation is a common equine arrhythmia. Quinidine alone, or with digoxin are common treatments. Studies on outcome in Warmblood populations in which duration of the AF is often unknown are limited. To identify the factors that are associated with the success of full treatment cardioversion with oral medication, and establish whether there are differences in these factors between institutions. Retrospective case series using patient records of Equine University Clinic of Utrecht University and Rossdales Equine Hospital, Newmarket. Forty-nine horses treated with quinidine were identified (29 Warmbloods, 20 Thorougbreds, 1 Anglo-Arabian). Details of signalment, history, duration physical examination and echocardiography including left atrial size and presence of mitral regurgitation were retrieved. Clinical details including mean weight, age and left atrial size were compared between clinics using independent samples t test. Association between variables and cardioconversion were evaluated in a backwards logistic regression using Akaike's information criterium (AIC) and odds ratios were calculated. Factors were sex, clinic, breed, mitral regurgitation, duration and poor performance. Covariates were age, weight and the size of the left atrium. Significance was set at 0.05. Fifty-one horses (mean age 8.8 s.d. 4.5 years) were treated with quinidine sulfate, 18 also received digoxin. Eighty per cent converted to sinus rhythm. In 8 horses the known duration was less than 3 months. The only factor associated with successful treatment was the use of digoxin in combination with quinidine sulfate (odds ratio 12.4; 95% CI 2.61 and 91.85 according to AIC analysis). In this retrospective case series, there is much potential for bias in the data; however, the use of digoxin in addition to quinidine was associated with improved conversion rates regardless of breed even though AF duration was unknown in most horses. Ethical animal research: Research ethics committee oversight not currently required by this conference: retrospective study of clinical records. Explicit owner informed consent for inclusion of animals in this study was not stated. None. Competing interests: None declared.

Prognostic implications of ischemic mitral regurgitation following non-ST-Segment elevation acute myocardial infarction

Introduction: Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. However, few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Aim: Investigate the clinical predictors of ischemic MR and its impact on the outcome after 1st NSTEMI . Methods: 40 consecutive patients were selected retrospectively after a first NSTEMI. Each underwent echocardiography and coronary angiography during their hospital admission. Patients were divided into two groups according to the presence or absence of MR at echocardiography: Group I : 20 patients without MR , Group II : 20 patients with MR. The patients were followed up clinically for at least one year. The incidence of readmission for heart failure, unstable angina, reinfarction, or all combined (i.e, major adverse cardiac event [MACE]) was recorded. Results: The patients’ mean age was 59.62 ± 10.97 years and 67.5 % were male. They were followed–up for a median of 640.5 days . No significant differences between both groups regarding baseline data ,cardiac isoenzymes , or revascularization (P > 0.05) , but there was significantly increased number of diseased coronary arteries in MR group (P 0.04). LA diameter was significantly increased with decreased LVEF% and increased wall motion abnormalities in MR group ((P < 0.05) . During follow-up period ,more admissions for unstable angina were seen in patients with MR but with little significance (P 0.05) . Regarding MACE, a greater incidence was found in the MR group (P<.05). Using Kaplan-Meier curves ,a long-term association of MACE with the presence of MR was found (P 0.04), and a higher grades of MR were associated with poor prognosis (P .05) . In conclusion: Ischemic MR yield poor prognosis. Thus, current MR should be carefully assessed after an NSTEMI,and probably requires even more meticulous treatment including early revascularization and stricter follow-up than usual .

Noncoronary Inflammation in Kawasaki Disease is Associated with Abnormal Myocardial Deformation in the Acute Phase

Patients with Kawasaki disease (KD) are at risk for developing coronary artery lesions, but the association of noncoronary changes such as mitral regurgitation (MR) and/or pericardial effusion (PE) with cardiac mechanics in the acute phase of KD has not been previously described. The aim of this study was to test the hypothesis that these noncoronary markers for carditis are associated with abnormalities in strain (ε) and strain rate (SR) in patients with MR or PE not appreciated by conventional echocardiography. Longitudinal and circumferential ε and SR analyses were retrospectively performed on patients with KD. Patients with and without MR or PE were compared. Strain values were also compared between patients with and without coronary artery lesions. Values for ejection fraction, shortening fraction, and clinical laboratory parameters were correlated with MR or PE. Follow-up echocardiographic outcomes were recorded at the first encounter after initial diagnosis. Follow-up ε and SR data were also obtained in the group with MR or PE and altered ventricular mechanics at diagnosis. Of the 110 patients reviewed, 92 had appropriate image quality for either longitudinal ε and SR or circumferential ε and SR analysis. Twenty-eight patients (30%) had either MR or PE. Longitudinal ε and SR were significantly decreased in patients with MR or PE compared with patients without MR or PE (ε: -16.4±4.0% vs -19.0±3.7%, P=.004; SR: -1.3±0.7 vs -1.6±0.4 sec(-1), P=.03). No significant difference in longitudinal ε or SR was noted between patients with and without coronary artery lesions (ε: -17.9±4.1% vs -17.8±3.8%, P=.50; SR: -1.5±0.3 vs -1.6±0.8 sec(-1), P=.50). In the group with abnormal coronary arteries, presence of MR or PE was correlated with decreased longitudinal ε (-16.1±3.6% vs -18.9±3.4%, P=.02), without a significant difference in longitudinal SR (-1.6±0.4 vs -1.5±0.4 sec(-1), P=.20). At approximately 3-week follow-up (21.3±15.8days), longitudinal ε and SR for the group with MR or PE had increased significantly compared with diagnosis (ε: -16.4±4.3% vs -18.6±0.5%, P=.03; SR: -1.3±0.6 vs -1.8±0.4 sec(-1), P=.008), coincident with resolution of MR or PE. In both groups, erythrocyte sedimentation rate and C-reactive protein were elevated (85.3±36.2 mm/h vs 75.1±33.1mm/h [P=.34] and 12.3±6.7 vs 11.7±8.2mg/dL [P=.83]), but only modest correlations were noted between longitudinal ε and elevated erythrocyte sedimentation rate (r=0.52, P=.01; confidence interval, 0.10-0.80) and C-reactive protein (r=0.50, P=.02; confidence interval, 0.10-0.80) in patients with MR or PE. Shortening fraction and ejection fraction were within the normal range in both groups. Patients presenting with KD with MR or PE at diagnosis are likely to have altered ventricular mechanics compared with patients with KD without MR or PE despite normal conventional echocardiographic measures of function. There is no significant difference in ventricular mechanics when comparing patients with KD with coronary ectasia or aneurysms and those without coronary lesions. Presence of abnormal ε in patients with KD with altered ventricular mechanics correlates modestly with laboratory inflammatory markers. Peak systolic longitudinal ε and SR increased significantly at 3-week follow-up compared with initial diagnosis, coincident with resolution of MR or PE.

Impact of DRG billing system on health budget consumption in percutaneous treatment of mitral valve regurgitation in heart failure

Objective:Percutaneous correction of mitral regurgitation (MR) by MitraClip (Abbot Vascular, Abbot Park, Illinois, USA) trans-catheter procedure (MTP) may represent a treatment for an unmet need in heart failure (HF), but with a largely unclear economic impact.Research design and methods:This study estimated the economic impact of the MTP in common practice using the disease-related group (DRG) billing system, duration and average cost per day of hospitalization as main drivers. Life expectancy was estimated based on the Seattle Heart Failure Model. Quality-of-life was derived by standard questionnaires to compute quality-adjusted year-life costs.Results:Over 5535 discharges between 2012–2013, HF as DRG 127 was the main diagnosis in 20%, yielding a reimbursement of €3052.00/case; among the DRG 127, MR by ICD-9 coding was found in 12%. Duration of hospitalization was longer for DRG 127 with than without MR (9 vs 8 days, p < 0.05). HF in-hospital management generated most frequently deficit, in particular in the presence of MR, due to the high costs of hospitalization, higher than reimbursement. MTP to treat MR allowed DRG 104-related reimbursement of €24,675.00. In a cohort of 34 HF patients treated for MR by MTP, the global budget consumption was 2-fold higher compared to that simulated for those cases medically managed at 2-year follow-up. Extrapolated cost per quality-adjusted-life-years (QALY) for MTP at year-2 follow-up was ∼€16,300.Conclusions:Based on DRG and hospitalization costing estimates, MTP might be cost-effective in selected HF patients with MR suitable for such a specific treatment, granted that those patients have a clinical profile predicting high likelihood of post-procedural clinical stability in sufficiently long follow-up.

The definition of valvular and non-valvular atrial fibrillation: results of a physicians' survey.

To assess different aspects of the definition of valvular/non-valvular atrial fibrillation (AF) used in clinical practice by physicians who usually treat this condition. We prospectively conducted a web-based survey including cardiologists and internists who attended continuing medical education courses on cardiovascular medicine. A questionnaire was drawn up, containing 17 questions clustered into five main topics: (A) known rheumatic aetiology; (B) site/type of valve involvement; (C) prosthetic heart valve; (D) haemodynamic relevance; (E) miscellaneous. The overall response rate was 22.4% (21.1% for cardiologists and 24% for internists). Coexistence of both medical history of rheumatic disease and clinical signs of valvular involvement were considered as essential prerequisites for the diagnosis of rheumatic AF by half of the respondents, and one-third assumed that lone aortic valve disease was sufficient for AF to be defined as valvular. A similar proportion of respondents considered that in the presence of mitral regurgitation, AF had to be defined as valvular. The majority of responding physicians considered the degree of valvular defect of lesser importance for the definition of valvular or non-valvular origin of AF. We found important heterogeneity and uncertainties in the answers given by physicians who usually treat patients with AF, as evidence of the lack of precise and unique definitions of the origin of AF (valvular/non-valvular). It is urgent to issue clear widely accepted definitions of the origin of AF, which should improve clinical practice and research.

Submitral Aneurysm: A Rare Congenital Anomaly

Submitral aneurysm is a congenital out pouching of the left ventricular wall invariably occurring adjacent to the posterior mitral leaflet. This rare congenital cardiac anomaly was initially described among the African population and is considered rare in the other parts of world. The clinical picture is dominated by congestive cardiac failure in the presence of mitral regurgitation. Echocardiography provides precise non-invasive diagnosis. The literature is reviewed to increase the awareness of clinicians, especially novice echocardiographers about this rare cardiac anomaly when coming across congestive cardiac failure with mitral regurgitation in young population.

Long-Term Prognostic Value of Mitral Regurgitation in Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

The presence of mitral regurgitation (MR) is associated with an impaired prognosis in patients with ischemic heart disease. However, data with regard to the impact of this condition in patients with ST-segment elevation myocardial infarction (STEMI) treated by means of primary percutaneous coronary intervention (PPCI) are lacking. Our aim was to assess the effect of MR in the long-term prognosis of patients with STEMI after PPCI. We analyzed a prospective registry of 1,868 patients (mean age 62 ± 13years, 79.9% men) with STEMI treated by PPCI in our center from January 2006 to December 2010. Our primary outcome was the composite end point of all-cause mortality or admission due to heart failure during follow-up. After exclusions, 1,036 patients remained for the final analysis. Moderate or severe MR was detected in 119 patients (11.5%). Those with more severe MR were more frequently women (p <0.001), older (p <0.001), and with lower ejection fraction (p <0.001). After a median follow-up of 2.8 years (1.7 to 4.3), a total of 139 patients (13.4%) experienced our primary end point. There was an association between the unfavorable combined event and the degree of MR (p <0.001). After adjustment for relevant confounders, moderate or severe MR remained as an independent predictor of the combined primary end point (adjusted hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.57 to 6.27) and each event separately (adjusted HR death 3.1, 95% CI 1.34 to 7.2; adjusted HR heart failure 3.3, 95% CI 1.16 to 9.4). In conclusion, moderate or severe MR detected early with echocardiography was independently associated with a worse long-term prognosis in patients with STEMI treated with PPCI.

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

In patients with acute myocardial infarction, the presence of mitral regurgitation (MR) is clinically important. The reported prevalence of MR after myocardial infarction varies. Bursi et al1 have pointed out that the prevalence varies between 1.6% and 19% in angiographic studies, but may be higher in echocardiographic studies. Indeed, among 773 patients undergoing echocardiography <30 days after infarction, MR was present in 50% of patients, of which MR was mild in 38% patients and moderate to severe in 12%.2 Thus, the variability in the reported prevalence of MR seems to be related to the technique used to assess its presence and to quantify its severity. It may also be related to the timing of MR assessment after infarction. In a recent report from the Valsartan in Acute Myocardial Infarction (VALIANT) study, the prevalence of MR was quantitatively assessed at baseline, 1 month, and 20 months in 341 patients after infarction.3 In this study, MR worsened by 1 degree in 78 patients (23%) and by 2 degrees in 10 patients (3%) after 20 months of follow-up. Conversely, 47 patients (14%) improved in MR by ≥1 degree, whereas in the remaining 206 patients (60%), the severity of MR remained unchanged. In particular, at 20 months follow-up, 15% of patients had moderate to severe MR. Article see p 890 It has been reported in various studies that patients with MR after infarction have a worse prognosis. In 1190 patients with acute infarction, the hazard ratios for development of heart failure, as compared with patients without MR, were 2.8 for patients with mild MR and 3.6 for patients with moderate to severe MR.4 In the same population, the hazard ratios for death were 1.2% (mild MR) and 2.0% (moderate to severe regurgitation). Similarly, Bursi et al2 reported a relative …

MitraClip® via direct right atrial access in case of a missing inferior vena cava

The presence of mitral regurgitation (MR) in patients with heart failure represents an independent predictor of mortality. Until now, the standard therapy for severe MR has been cardiac surgery in order to perform mitral valve replacement or mitral valve repair. With the introduction of the MitraClip® system (Abbott Vascular - Structural Heart, Menlo Park, CA, USA) in 2008, there is now an alternative percutaneous treatment option available for high-risk patients. We report on an 84-year-old male patient who was admitted to the emergency room with increasing shortness of breath due to severe functional MR, at stage NYHA III. In the following days the patient developed cardiogenic shock due to failure of the diuretic medication. The case first described here demonstrates an alternative transseptal route of access via a direct atrial puncture of the RA in a patient with absent inferior vena cava. This approach was successfully used to perform a MitraClip® procedure in this patient with functional MR and cardiogenic shock. It was possible to treat mitral regurgitation and the consecutive cardiogenic shock by implanting two MitraClips®.

Coronary artery bypass grafting in patients with left ventricular dysfunction: Predictors of long-term survival and impact of surgical strategies

BackgroundIn the surgical management of ischemic cardiomyopathy, factors associated with long-term prognosis after coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction are poorly understood. This study aimed to determine predictors of clinical outcomes in patients with severe LV dysfunction undergoing CABG. MethodsOut of 6084 patients who underwent CABG between 1997 and 2011, 476 patients (aged 62.6±9.3years, 100 females) were identified as having severe LV dysfunction (ejection fraction≤35%), preoperatively. All-cause mortality and adverse cardiac events (myocardial infarction, repeat revascularization, stroke and hospitalization due to cardiovascular causes) were evaluated during a median follow-up period of 55.2months (inter-quartile range: 26.4–94.8months). ResultsDuring the follow-up, 187 patients (39.3%) died and 126 cardiac events occurred in 104 patients (21.8%). Five-year survival and event-free survival rates were 72.1±2.2% and 61.3±2.4%, respectively. On Cox-regression analysis, old age (P<0.001), recent MI (P<0.001), history of coronary stenting (P=0.023), decreased glomerular filtration rate (P<0.001), and presence of mitral regurgitation (≥moderate) (P=0.012) or LV wall thinning (P=0.007) emerged as significant and independent predictors of death. After adjustment for important covariates affecting outcomes, none of the pump strategy (off-pump vs. on-pump), concomitant mitral surgery or surgical ventricular reconstruction (SVR) affected survival or event-free survival (P=0.082 to >0.99). ConclusionsLong-term survival following CABG in patients with severe LV dysfunction was affected by age, renal function, recent MI, prior coronary stenting, and presence of mitral regurgitation or LV wall thinning. Neither concomitant mitral surgery nor SVR, however, had significant influence on clinical outcomes.

Hereditary hemorrhagic telangiectasia, liver vascular malformations and cardiac consequences

BackgroundHHT patients with liver vascular malformations (VMs) may develop high-output cardiac failure requiring liver transplant in few cases. ObjectiveOur aim is to show that echocardiography is a good tool to evaluate the severity of hepatic vascular malformations in HHT and can improve medical management in HHT patients. MethodsThe study is a cross-sectional study of cardiac parameters in HHT patients with dyspnea in a single referral center. All HHT patients with dyspnea, consecutively seen at HHT reference center in Lyon between May 2007 and November 2009 were included and had hepatic vascular Ultrasound and Echocardiography. Echocardiographic measures included cardiac output (CO) and index (CI), left ventricle (LV) filling pressures, and pulmonary artery pressure. Then, patients were classified in 4 groups according to the severity: group 1 (normal values), group 2 with isolated high CI, group 3 with high CI and increased LV-filling pressures and group 4 with increased LV-filling pressures and pulmonary hypertension. ResultsFifty-two HHT-patients were analyzed. Eight patients were in group 1, 25 in group 2, 6 in group 3 and 13 in group 4. Age, NYHA class dyspnea, edema, atrial fibrillation, hepatic artery diameter, and BNP (brain natriuretic peptide) levels significantly increased from groups 1 to 4 as well as left atrial area, and presence of mitral regurgitation. Patients with associated pulmonary VMs (n=11) did not show any clinical or echocardiographic differences. ConclusionPerforming echocardiography in HHT patients with dyspnea allowed us to better understand the physiological processes of high-CO failure complicating liver vascular malformations and may improve follow-up of patients and treatment decisions.

Idiopathic dilated cardiomyopathy in children: Prognostic indicators and outcome

Objectives: Dilated cardiomyopathy is heterogeneous group of myocardial disease characterized by cardiac dilatation and impaired myocardial contractility. Despite on intensive search of cause using the most advanced molecular methods, the majority of cases have to be designated as idiopathic. The prognosis is often poor. In this study, we aimed to determine the outcome of Iraqi children with idiopathic dilated cardiomyopathy and features that might be useful as prognostic indicators. Materials and Methods: The records of 50 Iraqi children with idiopathic dilated cardiomyopathy whomat- tend children welfare Teaching Hospital from January 2004 to July 2006 were collected for retrospective study to detect factors that might predict outcome. For each patient, the following data were collected: age, gender, family history of heart disease, previous viral illness, and echocardiographic finding (ejection fraction and presence of mitral regurgitation on presentation). Results: Of 50 patients with idiopathic dilated cardiomyopathy, 29 patients (58%) were male and 21patients (42%) were female. The commonest age group affected was below 2 years age group (44%). On follow up, 5patients (10%) died, 6 patients (12%) eventually recovered, 12 patients (24%) labeled as compensated car- diomyopathy (dilated LV and normal LV function), while 27 patients (45%) continue to have chronic heart failure without any improvement(p<0.05). Conclusions: Our study revealed thatIraqi children with idiopathic dilated cardiomyopathy have variable out- come. The diagnosis of idiopathic dilated cardiomyopathy in infancy associated with poor prognosis whereas- the diagnosis of idiopathic dilated cardiomyopathy beyond infancy associated with better prognosis.

155: Quantification of mitral regurgitation by calculation of regurgitant volume: 3D left ventricular echocardiography versus PISA

Quantification of mitral regurgitation (MR) by echocardiography is well established using several echo or Doppler parameters in which effective regurgitation office area (ERO) and regurgitant volume (RV) are the most commonly used. However, hemispheric assumptions allowing application of proximal isovelocity area (PISA) may be erroneous due to complex mitral valve morphology (i.e. mitral valve prolapse). We hypothesized that 3D left ventricular echocardiography associated with pulse Doppler could obtain RV with high reliability for comparison of 2 methods (3D vs PISA) in presence of mitral regurgitation. Methods: First, in 50 patients without MR, we compared LV ejection volumes (LVEj) from a full volume 3D echocardiographic acquisition and 2D Simpson method to the aortic stroke volume (ASV) obtained by Pulsed Doppler for validation of the 3D approach. Second, we analyzed 50 patients with different degree MR for comparison of the two approaches and verification of PISA RV values. Inter and intra observer variabilities were assessed for all techniques. Results: Correlations and Bland&Altman methods gave high adequacy between 3D LVEj and ASV compared to 2D and ASV (respectively 3D, r=0.96, y=0.91x+4.8, mean error (ME) and 95% confidence interval of error (CIE) [−0.84±6 ml] and 2D, r=0.81, y=0.78x+5.8, [−5.41±16 ml]. Variabilities average for 3D LVEj was 6±3% and 15+/-5% for 2D. In patients with mitral regurgitation, RV from PISA and 3D LVEj were 23.1±12 ml and 24.5±11 ml (p=0.37) and the fractional regurgitation 32±13% and 33±12% (p=0.63). However, mean error measurement was −1.37 ml and 95% confidence interval of error was 17.90 ml showing high discrepancy between the two methods. By selecting a cut-off of 5, 10, 15 ml, numbers of patients with uncorrected measurements was 48.5, 17 and 8.5%. When using ASE 4 grades classification, 25,7% of misclassified patients was obtained with PISA. Conclusion: 3D LVEj method is robust and reliable for calculation of mitral regurgitant volumes with significant differences compared than those obtained with PISA which seems to be less adequate for all types of MR.

Abstract 18248: Should We Refrain to Perform TAVI Procedures in Patients with a Mitral Regurgitation? Insights from the FRANCE 2 Registry

Background: The presence of mitral regurgitation (MR) is an independent predictor of mortality after conventional aortic valve replacement for aortic stenosis. The predictive value of pre-procedural MR on clinical outcome after TAVI is unknown. Methods: 3,195 consecutive patients were enrolled between January 2010 and October 2011 in 33 centres. MR was graded according to pre-procedural transthoracic echocardiography (TTE) as none/trivial (=0), mild (=1), moderate (=2), moderate-to-severe (=3), or severe (=4). The mean age was 82±7 years; 49% were female and mean logistic EuroSCORE was 21.9±14.3. Balloon (BE) and self-expendable (SE) devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were transarterial (transfemoral: 74.6%; subclavian: 5.8%), transapical (17.8%), and transaortic (1.8%). Results: Pre-procedural TTE showed no MR in 32% of cases, a grade 1 MR in 46% of cases, a grade 2 MR in 20% of cases and a grade 3-4 in 2% of cases. Procedural success rate was 96.9%. Actuarial 1 year mortality was 19.5%. By univariate analysis, pre-procedural MR grade≥2, MR Grade=1 and MR Grade=0 were associated with a 1 year mortality rate of 24.0%, 20.1% and 15.8%, respectively (p=0.002). By multivariate analysis, 4 independent baseline characteristics were associated with preprocedural MR: a higer Logistic EuroSCORE (p=0.0001), a lower ejection fraction (p=0.0002), a higher NYHA class (p=0.0007), and female gender (p=0.001). By multivariate Cox analysis, independent predictors of one-year mortality were: logistic EuroSCORE (p=0.0001), NYHA class (p=0.0001) and transapical approach (p=0.0005). The presence of preprocedural MR was not significantly associated with 1-year mortality (p=0.31). Results did not differ when analyses were restricted only to BE or only to SE devices. Conclusion: A mild (grade1) or a moderate (grade 2) MR preprocedural is associated with a higher 1-year mortality after TAVI. However, since preprocedural MR is associated with a higher NYHA class or a higher logistic Euroscore, pre-procedural MR is not an independent predictor of mortality. These findings suggest that, in itself, the presence of a mild or a moderate MR should not refrain from performing TAVI and should not impact the type of valve to be used

Left atrial volume index as a marker of left ventricular diastolic dysfunction in asymptomatic Tanzanian diabetic patients

Aim: To determine the prevalence of left atrial (LA) enlargement and its relation to left ventricular (LV) diastolic dysfunction among asymptomatic diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods: Echocardiography was performed in 122 type 2 and 58 type 1 diabetic patients. Diastolic dysfunction was defined as peak transmitral blood velocity to medial mitral annulus velocity (E/E’) ratio ≥ 15. LA volume indexed to body surface area (LAVI) was considered enlarged if ≥ 29 ml/m2. Results: Enlarged LAVI and LV diastolic dysfunction were more common in type 2 than in type 1 diabetic patients (44.3 vs 25.9% and 20.5 vs 3.5%, respectively, both p < 0.05). In multivariate linear regression analysis, larger LAVI was associated with LV diastolic dysfunction independent of significant associations with LV mass index and presence of mitral regurgitation in type 2 diabetic patients, while LV mass index, lower ejection fraction and longer duration of diabetes were the main covariates of larger LAVI in type 1 diabetic patients (all p < 0.05). Conclusion: Enlarged LA is common among asymptomatic Tanzanian diabetic patients, and particularly associated with LV diastolic dysfunction in type 2, and with cardiomyopathy and lower systolic function in type 1 diabetic patients.

Mitral Leaflet Separation Index in Assessing the Severity of Mitral Stenosis

Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. The mitral valve area (MVA) can be measured by planimetry, pressure half-time, continuity equation, and proximal isovelocity surface area methods. In this study, we propose a novel yet simple, independent measure of MS severity–the mitral leaflet separation (MLS) index. This new index could be a useful surrogate measure of the MVA. This index would also help when there is a discrepancy between severities of MS estimated by existing methods, in the presence of atrial fibrillation and in the presence of mitral regurgitation.

The impact of mitral regurgitation on patients undergoing catheter ablation of atrial fibrillation

Mitral regurgitation (MR) causes left atrium (LA) enlargement and subsequent atrial fibrillation (AF). The presence of MR may increase recurrence rates after AF ablation. The purpose of this study was to determine the impact of MR on recurrence rates after catheter ablation of AF. We compared 95 patients with moderate or greater baseline MR (defined by MR jet area to LA area ratio ≥ 0.2) and AF undergoing ablation to 95 randomly selected patients without significant MR undergoing AF ablation. Electrocardiographic recurrence at 1-year follow-up was the primary outcome. Patients in the MR cohort had mean MR/LA ratio 0.37 vs. 0.09 in controls (P< 0.0001). Mitral regurgitation patients had larger LA dimension (4.5 vs. 4.1 cm, P< 0.0001) and more persistent AF (71 vs. 28%, P< 0.0001). Mitral regurgitation patients had higher recurrence rates than controls (61 vs. 46%, P= 0.04). The degree of MR was higher in patients with recurrence (MR/LA ratio 0.25 vs. 0.20, P= 0.03), as was LA dimension (4.5 vs. 4.1 cm, P< 0.0001). In multivariate analyses, only LA size was an independent predictor of recurrence (odds ratio 2.9 per centimetre increase in LA dimension, P= 0.005). Fifty-five percent of MR patients had normal leaflet motion, with MR likely due to atrial remodelling secondary to AF. Mitral regurgitation was associated with increased AF recurrence after AF ablation, but its impact was mediated by LA size. Left atrium size was the only independent predictor of AF recurrence. The high percentage of MR that was likely secondary to AF may have impacted our findings and deserves further study.