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Goyal A, Sulaiman SA, Safi D, Mehta K, Jain H, Jain J, Maheshwari S, Mahalwar G. Transcatheter Edge-to-Edge Repair in Valvular Heart Disease: A Comprehensive Exploration of Equipment, Efficacy, Gender, Racial, and Socioeconomic Disparities, and Future Prospects. Cardiol Rev 2024:00045415-990000000-00292. [PMID: 38970476 DOI: 10.1097/crd.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
The 2 primary components of valvular heart disease are mitral regurgitation (MR) and tricuspid regurgitation (TR). Transcatheter edge-to-edge repair (TEER) is an advanced, minimally invasive procedure that has recently displayed encouraging outcomes in the treatment of these pathologies. TEER offers a nonsurgical alternative for individuals diagnosed with conditions deemed to be high-risk surgical candidates. Currently, the TEER procedure employs devices such as MitraCLIP and TriCLIP, as well as innovative PASCAL (transcatheter valve repair system used for mitral and tricuspid valve repair) and FORMA (repair system used for tricuspid valve repair) repair systems. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial enrolling 614 patients to test the efficacy of TEER in MR, a significant reduction in hospitalization due to heart failure was observed at 24 months in the MitraClip + guideline-directed medical therapy (GDMT) group (35.8%) than in the GDMT-alone group (67.9%), HR, 0.53; P < 0.001, lower rate of all-cause mortality at 29.1% compared with 46.1% (P < 0.001), lower risk of cerebrovascular events (P = 0.001), and lower mortality due to cardiovascular events (P < 0.001). In another trial, patients with moderate TR or greater than New York Heart Association Class II or higher underwent TEER using the TriClip for the management of TR. The outcomes were encouraging, with 86% of patients showing a reduction in TR severity of at least one grade. As the technology and research surrounding TEER continue to progress, a more extensive range of patients are expected to qualify for TEER procedures. Our comprehensive review sought to extensively explore the background, equipment used, effectiveness of MR and TR, potential side effects, future prospects, and ongoing trials associated with TEER. We further discuss the existing gender, racial, and socioeconomic disparities in the realm of TEER.
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Affiliation(s)
- Aman Goyal
- From the Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, School of Medicine, University of Jordan, Amman, Jordan
| | - Darsh Safi
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Kahan Mehta
- Department of Internal Medicine, GMERS Medical College-Vadodara, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
| | - Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS)-Jodhpur, Jodhpur, Rajasthan, India
| | - Surabhi Maheshwari
- Department of Internal Medicine, G.M.E.R.S. Medical College and Hospital, Sola, Gujarat, India
| | - Gauranga Mahalwar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
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Marcoff L, Koulogiannis K, Aldaia L, Mediratta A, Chadderdon SM, Makar MM, Ruf TF, Gößler T, Zaroff JG, Leung GK, Ku IA, Nabauer M, Grayburn PA, Wang Z, Hawthorne KM, Fowler DE, Dal-Bianco JP, Vannan MA, Bevilacqua C, Meineri M, Ender J, Forner AF, Puthumana JJ, Mansoor AH, Lloyd DJ, Voskanian SJ, Ghobrial A, Hahn RT, Mahmood F, Haeffele C, Ong G, Schneider LM, Wang DD, Sekaran NK, Koss E, Mehla P, Harb S, Miyasaka R, Ivannikova M, Stewart-Dehner T, Mitchel L, Raissi SR, Kalbacher D, Biswas S, Ho EC, Goldberg Y, Smith RL, Hausleiter J, Lim DS, Gillam LD. Echocardiographic Outcomes With Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation in Prohibitive Surgical Risk Patients. JACC Cardiovasc Imaging 2024; 17:471-485. [PMID: 38099912 DOI: 10.1016/j.jcmg.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 06/09/2024]
Abstract
BACKGROUND The CLASP IID randomized trial (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) demonstrated the safety and effectiveness of the PASCAL system for mitral transcatheter edge-to-edge repair (M-TEER) in patients at prohibitive surgical risk with significant symptomatic degenerative mitral regurgitation (DMR). OBJECTIVES This study describes the echocardiographic methods and outcomes from the CLASP IID trial and analyzes baseline variables associated with residual mitral regurgitation (MR) ≤1+. METHODS An independent echocardiographic core laboratory assessed echocardiographic parameters based on American Society of Echocardiography guidelines focusing on MR mechanism, severity, and feasibility of M-TEER. Factors associated with residual MR ≤1+ were identified using logistic regression. RESULTS In 180 randomized patients, baseline echocardiographic parameters were well matched between the PASCAL (n = 117) and MitraClip (n = 63) groups, with flail leaflets present in 79.2% of patients. Baseline MR was 4+ in 76.4% and 3+ in 23.6% of patients. All patients achieved MR ≤2+ at discharge. The proportion of patients with MR ≤1+ was similar in both groups at discharge but diverged at 6 months, favoring PASCAL (83.7% vs 71.2%). Overall, patients with a smaller flail gap were significantly more likely to achieve MR ≤1+ at discharge (adjusted OR: 0.70; 95% CI: 0.50-0.99). Patients treated with PASCAL and those with a smaller flail gap were significantly more likely to sustain MR ≤1+ to 6 months (adjusted OR: 2.72 and 0.76; 95% CI: 1.08-6.89 and 0.60-0.98, respectively). CONCLUSIONS The study used DMR-specific echocardiographic methodology for M-TEER reflecting current guidelines and advances in 3-dimensional echocardiography. Treatment with PASCAL and a smaller flail gap were significant factors in sustaining MR ≤1+ to 6 months. Results demonstrate that MR ≤1+ is an achievable benchmark for successful M-TEER. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833).
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Affiliation(s)
- Leo Marcoff
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA.
| | | | - Lilian Aldaia
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | - Anuj Mediratta
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
| | | | - Moody M Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Jonathan G Zaroff
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Gordon K Leung
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Ivy A Ku
- Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | | | - Paul A Grayburn
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | - Zuyue Wang
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | | | - Dale E Fowler
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | | | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | | | | | | | | | | | - Dustin J Lloyd
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | | | - Andrew Ghobrial
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | | | | | - Elana Koss
- Northwell-North Shore, Manhasset, New York, USA
| | - Priti Mehla
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Serge Harb
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | - Lucas Mitchel
- St. Vincent Heart Center of Indiana, Indianapolis, Indiana, USA
| | - Sasan R Raissi
- Ascension Saint Thomas Hospital, Nashville, Tennessee, USA
| | | | | | - Edwin C Ho
- Montefiore Medical Center, Bronx, New York, USA
| | | | - Robert L Smith
- Baylor Scott and White: The Heart Hospital, Plano, Texas, USA
| | | | - D Scott Lim
- University of Virginia Health System Hospital, Charlottesville, Virginia, USA
| | - Linda D Gillam
- Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA
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Power JE, Reiff C, Tsangaris A, Hall A, Raveendran G, Yannopoulos D, Gurevich S. Invasive hemodynamics are equivocal for functional outcomes after MitraClip. Health Sci Rep 2022; 5:e471. [PMID: 35036576 PMCID: PMC8753491 DOI: 10.1002/hsr2.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes. Background Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes. Methods Sixty-nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi-squared test for categorical variables. Mann-Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes. Results A total of 69 patients were included in the study. The mean age was 83 (75-87) years and 38 (55%) were male. Eighty-one percentage had >/= NYHA III symptoms. Eighty-seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15-24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes. Conclusion Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.
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Affiliation(s)
- Juliette E Power
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Chris Reiff
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Adamantios Tsangaris
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Alexandra Hall
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Ganesh Raveendran
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Demetris Yannopoulos
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
| | - Sergey Gurevich
- Department of Medicine, Cardiovascular Division University of Minnesota Medical School Minneapolis Minnesota USA
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Kang JJH, Bozso SJ, El-Andari R, Adams C, Nagendran J. Transcatheter mitral valve repair and replacement: the next frontier of transcatheter valve intervention. Curr Opin Cardiol 2021; 36:163-171. [PMID: 33044266 DOI: 10.1097/hco.0000000000000803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW We summarize the recent developments in transcatheter mitral valve repair (TMVr) and replacement (TMVR), discuss determinants of MitraClip outcomes in various mitral regurgitation causes, and highlight newly emerging devices and randomized trials. RECENT FINDINGS The discordant results published in the two recent randomized trials for MitraClip, the COAPT and the MITRA-FR trial have led to the emergence of a new conceptual framework such as the proportionate versus disproportionate mitral regurgitation and hemodynamics assessment tools like the real-time continuous left atrial pressure monitoring. Learning curve and volume-outcome analyses and studies examining the MitraClip usage in patients with degenerative mitral regurgitation are recent developments that have influenced MitraClip regulation and coverage. Several trials for TMVr devices that take an alternative approach to the edge-to-edge repair are underway and advancements in the TMVR technologies are continuing to progress to fill the unmet needs of treating high surgical risk patients whose complex valve anatomy make TMVr unfeasible. SUMMARY Evidence supports careful analysis of the valve area and left ventricular function in addition to the left atrial hemodynamics will improve the MitraClip outcome. Operator experience plays a greater effect when achieving excellent results with 1+ or less residual mitral regurgitation whereas surgical MVr volume did not influence TMVr outcome. Interventions on the complex primary mitral regurgitation remain under the surgical domain, but MITRA high risk (HR) and REPAIR mitral regurgitation trials are underway to evaluate the role of MitraClip in high to intermediate surgical risk patients with primary mitral regurgitation. Despite the slow developments in TMVR, the results of the early trials of its devices are promising.
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Affiliation(s)
| | - Sabin J Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton
| | | | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Abstract
During the last few years, there has been significant advances in the treatment of patients with severe mitral incompetence either too high risk for surgery or inoperable, this because of the improvements in percutaneous mitral valve prostheses, as alternative to the transcatheter mitral repair techniques. Percutaneous mitral valve replacement offers several advantages over the repair techniques, such as the opportunity to treat mitral valve with different anatomic characteristics, even the more complex ones, and the occasion to correct completely mitral regurgitation. The development of such prostheses has been a long process, still on the making. During the initial stages of the procedure, the transapical approach was preferred. On the other hand, the transseptal approach, which has already been used in some patients, is the proper development path for this transcatheter technique. Many valvular prostheses have been produced, each using a different mechanism for secure anchoring and elimination of regurgitation. Early mortality for this procedure, although decreasing since the preliminary studies, is still high, not only because the technology is still in its initial phase but also for the very high risk of the patients treated. It is foreseeable, though, that in the near future, as the technology and patients selection improves, better results will follow.
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Affiliation(s)
- Barbara Bellini
- Sezione di Cardiologia Interventistica, Istituto Scientifico San Raffaele, Milano, Italy
| | - Antonio Colombo
- Sezione di Cardiologia Interventistica, Istituto Scientifico San Raffaele, Milano, Italy
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Gasior T, Gavazzoni M, Taramasso M, Zuber M, Maisano F. Direct Percutaneous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: When and How. Front Cardiovasc Med 2019; 6:152. [PMID: 31788478 PMCID: PMC6855240 DOI: 10.3389/fcvm.2019.00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/07/2019] [Indexed: 11/13/2022] Open
Abstract
Mitral regurgitation (MR) is a frequent valvular disease among patients deemed too high risk for surgery. Echocardiography along with CT is the primary diagnostic tool for MR and offers a comprehensive 3D assessment in patient selection and screening for the optimal treatment method. The direct percutaneous mitral annuloplasty addresses the underlying mechanisms of functional MR with a less invasive, catheter-based approach. The here-described techniques proved a sufficient safety profile, delivered significant MR reduction in most of the cases, and were associated with a notable improvement of symptoms. Although long-term outcome assessment is needed to support these early reports, the percutaneous mitral annuloplasty is likely to set a new standard of treatment in the forthcoming future.
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Affiliation(s)
- Tomasz Gasior
- University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Mara Gavazzoni
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Michel Zuber
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
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7
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Guérin P. Continuous Direct Left Atrial Pressure During MitraClip Therapy: One Key to Clinical Success? JACC Cardiovasc Interv 2019; 12:137-139. [PMID: 30594515 DOI: 10.1016/j.jcin.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Patrice Guérin
- University Hospital of Nantes, l'Institut du Thorax, Interventional Cardiology Unit, Nantes, France.
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8
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Kuwata S, Taramasso M, Czopak A, Luciani M, Pozzoli A, Ho E, Ferrero Guadagnoli A, Saccocci M, Gaemperli O, Nietlispach F, Zuber M, Feldman T, Maisano F. Continuous Direct Left Atrial Pressure. JACC Cardiovasc Interv 2019; 12:127-136. [DOI: 10.1016/j.jcin.2018.07.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022]
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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10
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Colombo A, Buzzatti N. Initial experience with percutaneous mitral valves. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538141 DOI: 10.2459/jcm.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
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11
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Jansen R, Hart EA, Peters M, Urgel K, Kluin J, Tietge WJ, Zwart K, Sybrandy KC, Cramer MJM, Chamuleau SAJ. An easy-to-use scoring index to determine severity of mitral regurgitation by 2D echocardiography in clinical practice. Echocardiography 2017; 34:1275-1283. [PMID: 28833463 DOI: 10.1111/echo.13636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Mitral regurgitation (MR) grading by two-dimensional transthoracic echocardiography is challenging, but important to determine the best treatment strategy in patients with MR. Current guidelines advocate an integrative approach, although no recommendation is provided on how to do so. An easy-to-use index will be helpful for standardized and reproducible MR grading. METHODS Eleven echocardiographic parameters were retrospectively evaluated in 145 patients with moderate or severe MR. Parameters were scored positive or negative for severe MR, where expert panel consensus reading was considered as the reference standard. Logistic regression was performed, and adjusted coefficients were used to create a risk score for severe MR per patient (ROSE-index). The best cutoff with corresponding predictive values was determined. RESULTS Eighty-two percent of all parameters could be determined. Multivariable analysis revealed five parameters that remained significant predictors for severe MR: morphology, jet characteristics, vena contracta, systolic reversal, and left ventricular dimensions. With different weighing, a total score of 8 could be obtained. Median total ROSE-index score for moderate (2.0) and severe MR (5.0) did significantly differ. The cutoff score (≥4) revealed sensitivity 0.84 and specificity 0.83 to diagnose severe MR. Negative predictive value was 100% for score 0 and 1; score 6-8 showed a 100% positive predictive value. Inter- and intra-observer agreements were excellent (K-values >0.80). CONCLUSION Here, we propose an easy-to-use tool for integrated analysis of guideline parameters to assess MR severity. Using this so-called ROSE-index revealed reliable and reproducible assessment of severe MR (cutoff≥4) that may be helpful for clinical decision making.
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Affiliation(s)
- Rosemarijn Jansen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Einar A Hart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Urgel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Tietge
- Department of Cardiology, Diaconessenhuis Hospital Leiden, Leiden, The Netherlands
| | - Koen Zwart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten C Sybrandy
- Department of Cardiology, St. Jansdal Hospital Harderwijk, Harderwijk, The Netherlands
| | - Maarten J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Pierce EL, Rabbah JPM, Thiele K, Wei Q, Vidakovic B, Jensen MO, Hung J, Yoganathan AP. Three-Dimensional Field Optimization Method: Gold-Standard Validation of a Novel Color Doppler Method for Quantifying Mitral Regurgitation. J Am Soc Echocardiogr 2016; 29:917-925. [PMID: 27354250 DOI: 10.1016/j.echo.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate diagnosis of mitral regurgitation (MR) severity is central to proper treatment. Although numerous approaches exist, an accurate, gold-standard clinical technique remains elusive. The authors previously reported on the initial development and demonstration of the automated three-dimensional (3D) field optimization method (FOM) algorithm, which exploits 3D color Doppler ultrasound imaging and builds on existing MR quantification techniques. The aim of the present study was to extensively validate 3D FOM in terms of accuracy, ease of use, and repeatability. METHODS Three-dimensional FOM was applied to five explanted ovine mitral valves in a left heart simulator, which were systematically perturbed to yield a total of 29 unique regurgitant geometries. Three-dimensional FOM was compared with a gold-standard flow probe, as well as the most clinically prevalent MR volume quantification technique, the two-dimensional (2D) proximal isovelocity surface area (PISA) method. RESULTS Overall, 3D FOM overestimated and 2D PISA underestimated MR volume, but 3D FOM error had smaller magnitude (5.2 ± 9.9 mL) than 2D PISA error (-6.9 ± 7.7 mL). Two-dimensional PISA remained superior in diagnosis for round orifices and especially mild MR, as predicted by ultrasound physics theory. For slit-type orifices and severe MR, 3D FOM showed significant improvement over 2D PISA. Three-dimensional FOM processing was technically simpler and significantly faster than 2D PISA and required fewer ultrasound acquisitions. Three-dimensional FOM did not show significant interuser variability, whereas 2D PISA did. CONCLUSIONS Three-dimensional FOM may provide increased clinical value compared with 2D PISA because of increased accuracy in the case of complex or severe regurgitant orifices as well as its greater repeatability and simpler work flow.
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Affiliation(s)
- Eric L Pierce
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Jean Pierre M Rabbah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | | | - Qifeng Wei
- Philips Health Tech, Andover, Massachusetts
| | - Brani Vidakovic
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Morten O Jensen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Judy Hung
- Echocardiography Laboratory of the Massachusetts General Hospital, Boston, Massachusetts
| | - Ajit P Yoganathan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
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13
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Maisano F, Taramasso M, Nickenig G, Hammerstingl C, Vahanian A, Messika-Zeitoun D, Baldus S, Huntgeburth M, Alfieri O, Colombo A, La Canna G, Agricola E, Zuber M, Tanner FC, Topilsky Y, Kreidel F, Kuck KH. Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J 2015; 37:817-25. [DOI: 10.1093/eurheartj/ehv603] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
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Abstract
Percutaneous mitral valve therapies are emerging as an alternative option for high-risk patients who are not good candidates for conventional open-heart surgery. Recently, multiple technologies and diversified approaches have been developed and are under clinical study or in preclinical development. This article on transcatheter mitral annuloplasty devices, describes the different technologies, and reports on the initial clinical and preclinical experiences.
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Affiliation(s)
- Maurizio Taramasso
- Department of Cardiac Surgery, Herz-Gefäss Chirurgie, UniversitätsSpital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, San Raffaele Scientific Institute, Via Buonarroti 48, Milan 20145, Italy.
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15
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Grasso C, Capodanno D, Tamburino C, Ohno Y. Current status and clinical development of transcatheter approaches for severe mitral regurgitation. Circ J 2015; 79:1164-71. [PMID: 25947004 DOI: 10.1253/circj.cj-15-0447] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcatheter mitral valve intervention has emerged as an effective treatment option for symptomatic severe mitral regurgitation in patients considered to be inoperable or at high operative risk for surgical mitral valve surgery. Most transcatheter approaches are modifications of existing surgical approaches. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has the largest clinical experience to date, as it offers a sustained clinical benefit in selected patients. This review aims to provide an up-to-date overview of transcatheter mitral valve interventions, including leaflet repair, annuloplasty, and mitral valve implantation.
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Affiliation(s)
- Carmelo Grasso
- Department of Cardiology, Ferrarotto Hospital, University of Catania
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16
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Al Amri I, van der Kley F, Schalij MJ, Ajmone Marsan N, Delgado V. Transcatheter mitral valve repair therapies for primary and secondary mitral regurgitation. Future Cardiol 2015; 11:153-69. [PMID: 25760875 DOI: 10.2217/fca.15.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Mitral regurgitation is one of the most prevalent valvular heart diseases and its prevalence is related to population aging. Elderly patients with age-associated co-morbidities have an increased risk for conventional mitral valve surgery. Transcatheter mitral valve repair has emerged as a feasible and safe alternative in patients with contraindications for surgery or high operative risk. Several transcatheter mitral repair technologies have been developed during the last decade. While the development of some devices was abandoned due to suboptimal results, others demonstrated to be safe and effective and have been included in current practice guidelines. Not all technologies are suitable for all mitral anatomies and regurgitation mechanisms. Therefore, accurate evaluation of mitral valve anatomy and function are pivotal to the success of these therapies. Cardiac imaging plays a central role in selecting patients, guiding the procedure and evaluating the durability of the repair at follow-up.
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Affiliation(s)
- Ibtihal Al Amri
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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17
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Taramasso M, Maisano F. Transcatheter mitral valve repair - transcatheter mitral valve annuloplasty. EUROINTERVENTION 2014; 10 Suppl U:U129-35. [DOI: 10.4244/eijv10sua19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Timing of surgery in valvular heart disease: prophylactic surgery vs watchful waiting in the asymptomatic patient. Can J Cardiol 2014; 30:1035-45. [PMID: 25151286 DOI: 10.1016/j.cjca.2014.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/07/2014] [Accepted: 06/12/2014] [Indexed: 11/23/2022] Open
Abstract
In the absence of randomized controlled trial data, the management of patients with severe valvular heart disease without symptoms, ventricular dysfunction, or other identified triggers for surgery is controversial. In this review, we frame the debate between prophylactic surgery vs close follow-up until triggers occur (watchful waiting) for severe aortic stenosis and degenerative mitral regurgitation (MR), the 2 conditions for which the pros and cons of these approaches are best articulated. Classic high-gradient severe aortic stenosis is generally accurately diagnosed. In asymptomatic patients, stress testing can be used to confirm asymptomatic status and identify high-risk features including reduced exercise tolerance, exercise-induced symptoms, and absolute or relative hypotension. Resting echocardiographic predictors of disease progression and/or adverse events include very high gradients, rapid progression, and extensive calcification. Surgical risk calculators can help estimate perioperative morbidity/mortality with the ultimate choice of a medical vs a prophylactic surgical approach to be made after discussion with the patient. With degenerative MR, severity can be inaccurately estimated. Stress testing might clarify whether the patient is truly asymptomatic and identify features associated with worse prognosis and symptom onset. Selecting patients with high probability of repair can be challenging. Perioperative risk and postoperative risks including those of unanticipated valve replacement and recurrent MR after repair are also considerations. In aggregate, management of patients with valvular disease who are asymptomatic and who have no clear trigger for surgery is complex, requires individualization, and should be carried out by or in collaboration with a heart valve centre of excellence.
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19
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Aronson S, Mathew JP, Cheung AT, Shore-Lesserson L, Troianos CA, Reeves S. The Rationale and Development of an Adult Cardiac Anesthesia Module to Supplement the Society of Thoracic Surgeons National Database. Anesth Analg 2014; 118:925-32. [DOI: 10.1213/ane.0000000000000184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Zamorano JL, Fernández-Golfín C, González-Gómez A. Quantification of mitral regurgitation by echocardiography. Heart 2014; 101:146-54. [PMID: 24780908 DOI: 10.1136/heartjnl-2012-303498] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- José L Zamorano
- Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain
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21
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Denti P, Maisano F, Alfieri O. Devices for mitral valve repair. J Cardiovasc Transl Res 2014; 7:266-81. [PMID: 24452608 DOI: 10.1007/s12265-014-9543-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/14/2014] [Indexed: 12/29/2022]
Abstract
The natural history of severe mitral regurgitation (MR) is unfavorable, leading to left ventricular failure, atrial fibrillation, stroke, and death. Many patients affected by severe regurgitation (MR) do not currently undergo surgery, mainly due to the perceived risk of the procedure (old age, impaired left ventricular function, and comorbidities). Mitral transcatheter interventions carry the hope of minimizing risks while preserving clinical efficacy of surgical repair, as an alternative to conventional treatment. Multiple technologies and diversified approaches are under development with the purpose of treating MR in less invasive ways. They can be categorized based on the anatomical and patho-physiological addressed target. Among them, MitraClip (Abbott Vascular, Inc., Menlo Park, California) has emerged as a clinically safe and effective method for percutaneous mitral valve repair in patients either with degenerative and functional regurgitation. This device mimics the surgical edge-to-edge repair initially described by Alfieri in the early 1990s. Other repair technologies include percutaneous direct and indirect annuloplasty, neochordae implantation, and left ventricular reshaping. They are still in early phase clinical trials or preclinical studies. The combination of different repair techniques is likely to be required to achieve good long-lasting results. In the future, novel devices, improved knowledge, more efficient imaging, and transcatheter mitral prosthetic valve implantation may expand the indications to those patients currently not treated, as well as improve the results both in terms of early efficacy and long-term durability. These treatments are currently reserved to high-risk and inoperable patients, and their application requires an integrated Heart-Team approach. They represent the natural evolution of surgery and promise to expand treatment options and improve patients' outcomes in the near future.
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Affiliation(s)
- Paolo Denti
- San Raffaele University Hospital, Via Olgettina, 60, 20100, Milan, Italy,
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22
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Plicht B, Buck T. Novel Aspects of 3D Echocardiography in Percutaneous Mitral Valve Interventions: Update 2013. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Grayburn PA, Foster E, Sangli C, Weissman NJ, Massaro J, Glower DG, Feldman T, Mauri L. Relationship between the magnitude of reduction in mitral regurgitation severity and left ventricular and left atrial reverse remodeling after MitraClip therapy. Circulation 2013; 128:1667-74. [PMID: 24014834 DOI: 10.1161/circulationaha.112.001039] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND MitraClip has been shown to reduce mitral regurgitation (MR) severity safely but to a lesser degree than surgery. No data exist on the magnitude of MR reduction necessary to reverse left ventricular (LV) and left atrial (LA) dilation in patients with severe MR. Therefore, an analysis was performed to evaluate the relationship between MR reduction and LV and LA volumes after MitraClip therapy. METHODS AND RESULTS A total of 801 patients treated with MitraClip and 80 patients treated surgically were included. All patients had severe (3-4+) MR. MR severity, LV volumes at end-diastole and end-systole, and LA volumes were measured at baseline, discharge, 30 days, 6 months, and 1 year by an independent echocardiographic core laboratory. A linear repeated measures model was developed to determine the relationship between MR severity and time of measurement postindex procedure on longitudinal LV and LA volumes. Separate models were fit for functional MR and degenerative MR. In both degenerative and functional MR, reduction in LV volumes at end-diastole was associated with degree of residual MR at 12 months (P<0.0001). LV volumes at end-systole was significantly reduced in functional MR but not degenerative MR. LA volumes were significantly related to reduction of MR severity in both groups. CONCLUSIONS Reduction of LV volumes at end-diastole and LA volumes, but not LV volumes at end-systole in degenerative MR, is consistent with correction of volume overload from primary MR. Reduction of all 3 measurements in functional MR demonstrates reverse remodeling when MR severity is reduced to either 1+ or 2+ by MitraClip therapy. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00209274.
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Affiliation(s)
- Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX (P.A.G.); University of California, San Francisco (E.F.); Abbott Vascular Structural Heart, Menlo Park, CA (C.S.); MedStar Health Research Institute, Washington, DC (N.J.W.); Boston University School of Public Health, Harvard Clinical Research Institute, Boston, MA (J.M.); Duke University Medical Center, Durham, NC (D.G.G.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); and Brigham and Women's Hospital, Harvard Clinical Research Institute, Harvard Medical School, Boston, MA (L.M.)
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24
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Abstract
Mitral valve regurgitation (MR) is often diagnosed in patients with heart failure and is associated with worsening of symptoms and reduced survival. While surgery remains the gold standard treatment in low-risk patients with degenerative MR, in high-risk patients and in those with functional MR, transcatheter procedures are emerging as an alternative therapeutic option. MitraClip(®) is the device with which the largest clinical experience has been gained to date, as it offers sustained clinical benefit in selected patients. Further to MitraClip implantation, several additional approaches are developing, to better match with the extreme variability of mitral valve disease. Not only repair is evolving, initial steps towards percutaneous mitral valve implantation have already been undertaken, and initial clinical experience has just started.
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25
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Armstrong EJ, Rogers JH, Swan CH, Upadhyaya D, Viloria E, McCulloch C, Slater J, Qureshi M, Williams J, Whisenant B, Feldman T, Foster E. Echocardiographic predictors of single versus dual MitraClip device implantation and long-term reduction of mitral regurgitation after percutaneous repair. Catheter Cardiovasc Interv 2013; 82:673-9. [DOI: 10.1002/ccd.24645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/28/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Ehrin J. Armstrong
- Division of Cardiovascular Medicine; University of California; Davis Medical Center; Sacramento; California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; University of California; Davis Medical Center; Sacramento; California
| | - Christo H. Swan
- Division of Cardiology; University of California; San Francisco; California
| | - Deepa Upadhyaya
- Division of Cardiology; University of California; San Francisco; California
| | - Esperanza Viloria
- Division of Cardiology; University of California; San Francisco; California
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics; University of California; San Francisco; California
| | - James Slater
- Division of Cardiology; New York University Medical Center; New York
| | - Mansoor Qureshi
- Division of Cardiology; St Joseph Mercy Hospital; Ypsilanti; Michigan
| | - John Williams
- Division of Cardiology; Oklahoma Cardiovascular Research Group; Oklahoma City; Oklahoma
| | - Brian Whisenant
- Division of Cardiology; Intermountain Medical Center; Murray; Utah
| | - Ted Feldman
- Division of Cardiology; Evanston Hospital; NorthShore University HealthSystem; Evanston; IL
| | - Elyse Foster
- Division of Cardiology; University of California; San Francisco; California
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26
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Abstract
Real-time 3D echocardiography is one of the most important developments in the field of non-invasive cardiac imaging within the last years. To investigate whether this new technology can be considered as a standard method the current guidelines and recommendations were reviewed. In the field of left ventricular function assessment, evaluation of mitral valve pathologies and peri-interventional monitoring of percutaneous valve repair procedures 3D echocardiography plays a major role. For other clinical applications, such as right heart assessment, congenital heart disease and stress echocardiography, a high potential is seen but evidence is currently too weak for general recommendations. However, in the near future no echo laboratory will be working without 3D modalities.
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27
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Affiliation(s)
- Paul A Grayburn
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX 75226, USA.
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28
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Shames S, Gillam LD. Role of Echocardiography to Guide New Transcatheter Interventions for Valvular Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Grayburn PA. The Importance of Regurgitant Orifice Shape in Mitral Regurgitation. JACC Cardiovasc Imaging 2011; 4:1097-9. [DOI: 10.1016/j.jcmg.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 10/16/2022]
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