1
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Pienta MJ, Romano MA. Secondary Mitral Regurgitation and Transcatheter Mitral Valve Therapies: Do They Have a Role in Advanced Heart Failure with Reduced Ejection Fraction? Heart Fail Clin 2024; 20:437-444. [PMID: 39216928 DOI: 10.1016/j.hfc.2024.06.009] [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] [Indexed: 09/04/2024]
Abstract
Transcatheter mitral valve repair should be considered for patients with severe secondary mitral regurgitation with symptomatic heart failure with reduced ejection fraction for symptom improvement and survival benefit. Patients with a higher severity of secondary mitral regurgitation relative to the degree of left ventricular dilation are more likely to benefit from transcatheter mitral valve repair. A multidisciplinary Heart Team should participate in patient selection for transcatheter mitral valve therapy.
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Affiliation(s)
- Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Matthew A Romano
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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2
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Zancanaro E, Buzzatti N, Denti P, Guicciardi NA, Melillo E, Monaco F, Agricola E, Ancona F, Alfieri O, De Bonis M, Maisano F. Eligibility to COAPT trial in the daily practice: A real-world experience. Catheter Cardiovasc Interv 2024; 104:368-377. [PMID: 38923261 DOI: 10.1002/ccd.31124] [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: 03/06/2024] [Revised: 04/30/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COAPT Trial was the first ever to demonstrate a survival benefit in treating functional mitral regurgitation (FMR). That was achieved through transcatheter mitral repair in selected patients. The exact proportion of patients fulfilling COAPT selection criteria in the real-world is unknown. AIMS To assess the applicability of COAPT criteria in real world and its impact on patients' survival. METHODS We assessed the clinical data and follow-up results of all consecutive patients admitted for FMR at our Department between January 2016 and May 2021 according to COAPT eligibility. COAPT eligibility was retrospectively assessed by a cardiac surgeon and a cardiologist. RESULTS Among 394 patients, 56 (14%) were COAPT eligible. The most frequent reasons for exclusion were MR ≤ 2 (22%), LVEF < 20% or >50% (19%), and non-optimized GDMT (21.3%). Among Non-COAPT patients, weighted 4-year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% confidence interval [CI: 0.864, 0.96] vs. 71.8% [CI: 0.509, 0.926], respectively, p = 0.027). CONCLUSIONS Only a minority (14%) of real-world patients with FMR referred to a tertiary hospital fulfilled the COAPT selection criteria. Among Non-COAPT patients, weighted 4-year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% [0.864, 0.96] vs. 71.8% [0.509, 0.926], respectively, p = 0.027).
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Affiliation(s)
- Edoardo Zancanaro
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Enrico Melillo
- Department of Cardiology and Heart Failure, Monaldi Hospital, Naples, Italy
| | - Fabrizio Monaco
- Department of Cardiac Anesthesia, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
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3
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Milojevic M, Nikolic A, Bakaeen FG, Myers PO. Clinical practice guidelines: ensuring quality through international collaboration. Eur J Cardiothorac Surg 2024; 66:ezae237. [PMID: 38958045 DOI: 10.1093/ejcts/ezae237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 06/15/2024] [Indexed: 07/04/2024] Open
Affiliation(s)
- Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Aleksandar Nikolic
- Department of Cardiac Surgery, Acibadem Sistina Hospital, Skopje, North Macedonia
| | - Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick O Myers
- Division of Cardiac Surgery, CHUV-Lausanne University Hospital, Lausanne, Switzerland
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4
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Montagnon M, Chen Y, Grove A, Park J, Obadia JF, Armoiry X. Reconciling conflicting evidence in the evaluation of the MitraClip system: Assessment of and response to the MITRA-FR and COAPT trials by key stakeholders. J Evid Based Med 2024; 17:253-255. [PMID: 38783795 DOI: 10.1111/jebm.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Affiliation(s)
| | - Yenfu Chen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Amy Grove
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jieun Park
- Warwick Medical School, University of Warwick, Coventry, UK
- Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Xavier Armoiry
- Pharmacy Department, University of Lyon, Lyon, France
- Warwick Medical School, University of Warwick, Coventry, UK
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5
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Moonen A, Cao J, Celermajer DS, Ng MK. Mitral Regurgitation "Proportionality" in Functional Mitral Regurgitation and Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair: A Systematic Review and Meta-Analysis. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100284. [PMID: 38799800 PMCID: PMC11121745 DOI: 10.1016/j.shj.2024.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 05/29/2024]
Abstract
Background Certain patients with functional mitral regurgitation survive longer with fewer heart failure hospitalizations after undergoing transcatheter edge-to-edge repair (TEER); however, clinical markers identifying who will benefit have not been established. The 'proportionality' of mitral regurgitation (MR) severity compared to left ventricular size has been hypothesized to predict clinical outcome. Methods We sought to combine existing studies to compare outcomes between 'proportionate' MR and 'disproportionate' MR in patients undergoing TEER. PubMed and Medline were searched from January 2018 until May 2023. Data was extracted and synthesized by 2 independent authors using random effects models with risk ratios (RRs) for binary outcomes. The primary outcome was a combined endpoint of all-cause mortality or heart failure hospitalization (ACM/HFH). Other outcomes of interest included ACM and residual >2+ MR after TEER. Results Six trials with a total of 1594 patients (mean age 71 years, 66% male) were included, which assessed MR proportionality using either a ratio of estimated regurgitant orifice area to left ventricular end-diastolic volume (EROA:LVEDV) or regurgitant fraction. Seven hundred and five (mean age 70 years, 75% male) were classified as proportionate MR, and 889 (mean age 72 years, 60% male) had disproportionate MR. There was no significant association between MR proportionality (by EROA:LVEDV) and ACM (RR 0.79, 95% confidence interval [CI] 0.44-1.42). Proportionality did not significantly associate with ACM/HFH, though there were divergent effect signals when proportionality was measured by EROA:LVEDV (RR 0.80, 95% CI 0.45-1.44) or regurgitant fraction (RR 1.48, 95% CI 0.53-4.11). Disproportionate MR showed a greater association with residual MR > 2+ post-TEER that did not meet statistical significance (RR 1.86, 95% CI 0.77-4.49). Conclusions In patients undergoing TEER for functional mitral regurgitation, MR proportionality was not significantly associated with ACM/HFH, all-cause mortality, or residual MR.
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Affiliation(s)
- Avalon Moonen
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jacob Cao
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, St Vincent’s Hospital, Sydney, NSW, Australia
| | - David S. Celermajer
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Heart Research Institute, Sydney, NSW, Australia
| | - Martin K.C. Ng
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Heart Research Institute, Sydney, NSW, Australia
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6
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Niro L, Delgado V. Defining the Sweet Spot in Transcatheter Tricuspid Valve Interventions. JACC Cardiovasc Interv 2024; 17:871-873. [PMID: 38599689 DOI: 10.1016/j.jcin.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Lorenzo Niro
- Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Victoria Delgado
- Department of Cardiology, Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.
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7
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Okuno T, Izumo M, Shiokawa N, Kuwata S, Ishibashi Y, Sato Y, Koga M, Okuyama K, Suzuki N, Kida K, Tanabe Y, Akashi YJ. Impact of the MitraClip G4 System on Routine Practice and Outcomes in Patients With Secondary Mitral Regurgitation. Circ J 2024; 88:531-538. [PMID: 38008428 DOI: 10.1253/circj.cj-23-0503] [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] [Indexed: 11/28/2023]
Abstract
BACKGROUND The MitraClip G4 system is a new iteration of the transcatheter edge-to-edge repair system. We assessed the impact of the G4 system on routine practice and outcomes in secondary mitral regurgitation (2°MR). METHODS AND RESULTS Consecutive patients with 2°MR treated with either the MitraClip G2 (n=89) or G4 (n=63) system between 2018 and 2021 were included. Baseline characteristics, procedures, and outcomes were compared. Inverse probability of treatment weighting and Cox regression were used to adjust for baseline differences. Baseline characteristics were similar, except for a lower surgical risk in the G4 group (Society of Thoracic Surgeons Predicted Risk of Mortality ≥8: 38.1% vs. 56.2%; P=0.03). In the G4 group, more patients had short (≤2 mm) coaptation length (83.7% vs. 54.0%; P<0.001) and fewer clips were used (17.5% vs. 36.0%; P=0.02). Acceptable MR reduction was observed in nearly all patients, with no difference between the G4 and G2 groups (100% vs. 97.8%, respectively; P=0.51). The G4 group had fewer patients with high transmitral gradients (>5mmHg; 3.3% vs. 13.6%; P=0.03). At 1 year, there was no significant difference between groups in the composite endpoint (death or heart failure rehospitalization) after baseline adjustment (10.5% vs. 20.2%; hazard ratio 0.39; 95% confidence interval 0.11-1.32; P=0.13). CONCLUSIONS The G4 system achieved comparable device outcomes to the early-generation G2, despite treating more challenging 2°MR with fewer clips.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, St. Marianna University Hospital
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University Hospital
| | | | - Shingo Kuwata
- Department of Cardiology, St. Marianna University Hospital
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University Hospital
| | - Yukio Sato
- Department of Cardiology, St. Marianna University Hospital
| | - Masashi Koga
- Department of Cardiology, St. Marianna University Hospital
| | | | - Norio Suzuki
- Department of Cardiology, St. Marianna University Hospital
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
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8
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Brankovic M, Sharma A, Gardin JM, Waller AH. Disproportionate Mitral Regurgitation and Mortality After Transcatheter Mitral Valve Edge-to-Edge Repair. Am J Cardiol 2024; 215:89-90. [PMID: 38232810 DOI: 10.1016/j.amjcard.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Milos Brankovic
- Division of Cardiology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Alfonso H Waller
- Division of Cardiology, Department of Medicine; Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey
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9
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Duggal NM, Engoren M, Chadderdon SM, Rodriguez E, Morse MA, Vannan MA, Yadav PK, Morcos M, Li F, Reisman M, Garcia-Sayan E, Raghunathan D, Sodhi N, Sorajja P, Chen L, Rogers JH, Calfon MA, Kovach CP, Gill EA, Zahr FE, Chetcuti SJ, Yuan Y, Mentz GB, Lim DS, Ailawadi G. Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry. Am J Cardiol 2024; 213:99-105. [PMID: 38110022 DOI: 10.1016/j.amjcard.2023.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/20/2023]
Abstract
The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm2/ml, interquartile range [0.12,0.28] mm2/ml, and 187 patients (36%) had values <0.15 mm2/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.
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Affiliation(s)
- Neal M Duggal
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
| | - Milo Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Scott M Chadderdon
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Evelio Rodriguez
- Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - M Andrew Morse
- Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee
| | - Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Pradeep K Yadav
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael Morcos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Flora Li
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Mark Reisman
- Division of Cardiology, Weill Cornell Medical Center, New York, New York
| | - Enrique Garcia-Sayan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Deepa Raghunathan
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nishtha Sodhi
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota
| | - Lily Chen
- 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
| | - Marcella A Calfon
- Division of Cardiology, University of California Los Angeles, Los Angeles, California
| | | | - Edward A Gill
- Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Firas E Zahr
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stanley J Chetcuti
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yuan Yuan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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10
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Ambrožič J, Rauber M, Berlot B, Škofic N, Toplišek J, Bervar M, Cvijić M. Challenges and pitfalls in classification of disproportionate mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-03043-1. [PMID: 38159132 DOI: 10.1007/s10554-023-03043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
The concept of disproportionate mitral regurgitation (dispropMR) has been introduced to identify patients with functional mitral regurgitation (MR) who benefit from percutaneous treatment. We aimed to examine echocardiographic characteristics behind this entity. We retrospectively included 172 consecutive patients with reduced left ventricular ejection fraction (LVEF), and more than mild MR referred to clinically indicated echocardiography. According to the proportionality ratio (effective regurgitant orifice area (EROA)/left ventricular end-diastolic volume (LVEDV)) patients were divided into dispropMR and proportionate MR (propMR) group. Potential factors which might affect proportionality definition were analyzed. 55 patients (32%) had dispropMR. Discrepant grading of MR severity was observed when using regurgitant volume (RegVol) by proximal isovelocity surface area (PISA) method or volumetric method, with significant discordance only in dispropMR (p < 0.001). Patients with dispropMR had more frequently left ventricular foreshortened images for LVEDV calculation than patients with propMR (p = 0.003), resulting in smaller LVEDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR. Accordingly, EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method. This was more pronounced in dispropMR (bias:10.5 ± 28.3 mm2) compared to propMR group (bias:6.4 ± 12.8 mm2). DispropMR may be found in roughly one third of clinically indicated echocardiographic studies in patients with reduced LVEF and more than mild MR. EROA overestimation due to dynamic variation of regurgitant flow and LVEDV underestimation due to LV foreshortening were more frequently found in dispropMR. Our results indicate that methodological limitations of echocardiographic MR grading could not be neglected in classifying the proportionality of MR.
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Affiliation(s)
- Jana Ambrožič
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Martin Rauber
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Boštjan Berlot
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Nataša Škofic
- Department of Surgery, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Janez Toplišek
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Mojca Bervar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, 1000, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, 1000, Slovenia.
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11
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Pienta MJ, Romano MA. Secondary Mitral Regurgitation and Transcatheter Mitral Valve Therapies: Do They Have a Role in Advanced Heart Failure with Reduced Ejection Fraction? Cardiol Clin 2023; 41:575-582. [PMID: 37743079 DOI: 10.1016/j.ccl.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Transcatheter mitral valve repair should be considered for patients with severe secondary mitral regurgitation with symptomatic heart failure with reduced ejection fraction for symptom improvement and survival benefit. Patients with a higher severity of secondary mitral regurgitation relative to the degree of left ventricular dilation are more likely to benefit from transcatheter mitral valve repair. A multidisciplinary Heart Team should participate in patient selection for transcatheter mitral valve therapy.
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Affiliation(s)
- Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Matthew A Romano
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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12
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Orban M, Hausleiter J. Expanding Success of Mitral Transcatheter Edge-to-Edge Repair in Real-World Patients: And More Questions to Answer. J Am Coll Cardiol 2023; 82:1298-1300. [PMID: 37730285 DOI: 10.1016/j.jacc.2023.08.002] [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: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
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13
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Kumar M, Thompson PD, Chen K. New Perspective on Pathophysiology and Management of Functional Mitral Regurgitation. Trends Cardiovasc Med 2023; 33:386-392. [PMID: 35259483 DOI: 10.1016/j.tcm.2022.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 12/31/2022]
Abstract
Functional mitral regurgitation (FMR) occurs as a result of global or segmental left ventricular (LV) dysfunction or left atrial dilatation, leading to mitral annular dilatation, papillary muscle displacement, mitral valve (MV) leaflet tethering, and leaflet remodeling. The prevalence of FMR continues to rise in the United States. Even mild FMR is associated with adverse clinical outcomes. Echocardiography is the primary imaging modality used to assess the type and severity of mitral regurgitation. FMR treatment depends on the etiology. Evidence-based pharmacologic and cardiac resynchronization therapies for underlying LV dysfunction remain the mainstay of treatment. Patients who remain symptomatic despite optimal medical therapy can be considered for surgical or percutaneous MV intervention. This article reviews the pathophysiology, imaging evaluation, and therapeutic options of FMR, highlighting the most recent developments in a rapidly evolving field.
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Affiliation(s)
- Manish Kumar
- Pat and Jim Calhoun Cardiology Center, Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, 06030, United States.
| | - Paul D Thompson
- Department of Cardiology, Hartford Hospital, Hartford, 06106, United States
| | - Kai Chen
- Pat and Jim Calhoun Cardiology Center, Department of Internal Medicine, University of Connecticut Health Center, Farmington, CT, 06030, United States.
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14
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Fortmeier V, Lachmann M, Unterhuber M, Stolz L, Kassar M, Ochs L, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz K, Praz F, Windecker S, Hausleiter J, Lurz P, Rudolph V. Epiphenomenon or Prognostically Relevant Interventional Target? A Novel Proportionality Framework for Severe Tricuspid Regurgitation. J Am Heart Assoc 2023; 12:e028737. [PMID: 36926925 PMCID: PMC10111550 DOI: 10.1161/jaha.122.028737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/23/2023] [Indexed: 03/18/2023]
Abstract
Background Tricuspid regurgitation (TR) frequently develops in patients with long-standing pulmonary hypertension, and both pathologies are associated with increased morbidity and mortality. This study aimed to improve prognostic assessment in patients with severe TR undergoing transcatheter tricuspid valve intervention (TTVI) by relating the extent of TR to pulmonary artery pressures. Methods and Results In this multicenter study, we included 533 patients undergoing TTVI for moderate-to-severe or severe TR. The proportionality framework was based on the ratio of tricuspid valve effective regurgitant orifice area to mean pulmonary artery pressure. An optimal threshold for tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio was derived on 353 patients with regard to 2-year all-cause mortality and externally validated on 180 patients. Patients with a tricuspid valve effective regurgitant orifice area/mean pulmonary artery pressure ratio ≤1.25 mm2/mm Hg (defining proportionate TR) featured significantly lower 2-year survival rates after TTVI than patients with disproportionate TR (56.6% versus 69.6%; P=0.005). In contrast with patients with disproportionate TR (n=398), patients with proportionate TR (n=135) showed more pronounced mPAP levels (37.9±9.06 mm Hg versus 27.9±8.17 mm Hg; P<2.2×10-16) and more severely impaired right ventricular function (tricuspid annular plane systolic excursion: 16.0±4.11 versus 17.0±4.64 mm; P=0.012). Moreover, tricuspid valve effective regurgitant orifice area was smaller in patients with proportionate TR when compared with disproportionate TR (0.350±0.105 cm2 versus 0.770±0.432 cm2; P<2.2×10-16). Importantly, proportionate TR remained a significant predictor for 2-year mortality after adjusting for demographic and clinical variables (hazard ratio, 1.7; P=0.006). Conclusions The proposed proportionality framework promises to improve future risk stratification and clinical decision-making by identifying patients who benefit the most from TTVI (disproportionate TR). As a next step, randomized controlled studies with a conservative treatment arm are needed to quantify the net benefit of TTVI in patients with proportionate TR.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Mohammad Kassar
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Laurin Ochs
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Anne R. Schöber
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Thomas J. Stocker
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Maria I. Körber
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Amelie Hesse
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Kai Peter Friedrichs
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Shinsuke Yuasa
- Department of CardiologyKeio University School of MedicineTokyoJapan
| | - Tanja K. Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
| | - Michael Joner
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Department of Cardiology, German Heart Center MunichTechnical University of MunichMunichGermany
| | - Roman Pfister
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Stephan Baldus
- Department of Cardiology, Heart CenterUniversity of CologneCologneGermany
| | - Karl‐Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der IsarTechnical University of MunichMunichGermany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
| | - Fabien Praz
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Stephan Windecker
- Department of CardiologyInselspital Bern, Bern University HospitalBernSwitzerland
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Medizinische Klinik und Poliklinik IKlinikum der Universität München, Ludwig Maximilians University of MunichMunichGermany
| | - Philipp Lurz
- Department of Cardiology, Heart Center LeipzigUniversity of LeipzigLeipzigGermany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine‐WestphaliaRuhr University BochumBad OeynhausenGermany
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15
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Stolz L, Braun D, Higuchi S, Orban M, Doldi PM, Stocker TJ, Weckbach LT, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Transcatheter edge-to-edge mitral valve repair in mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2023; 20:99-108. [PMID: 35791872 DOI: 10.1080/17434440.2022.2098013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mitral regurgitation (MR) is associated with substantial morbidity and mortality. Within the past 15 years, mitral valve edge-to-edge repair (M-TEER) has developed from an experimental approach to a guideline-recommended, safe, and effective treatment option for patients with severe primary or secondary mitral regurgitation. AREAS COVERED This review covered relevant publications of M-TEER and summarizes the development of M-TEER devices within the last 15 years. It outlines anatomical challenges which drove the evolution of M-TEER devices, provides an overview about the current state of clinical application and research, and offers an outlook into the future of transcatheter mitral valve treatment. EXPERT OPINION The development and refinement of new M-TEER device generations offer the possibility to treat a wide range of mitral valve anatomies. Choosing the best device for the individual anatomic properties of the patients and considering comorbidities is the key to maximized MR reduction, minimalized complication rates, and thus optimized postinterventional prognosis. Independent from prognostic implications, quality of life has become an important patient-centered outcome that can be improved by M-TEER in virtually all patients treated.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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16
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Secondary Mitral Regurgitation: Cardiac Remodeling, Diagnosis, and Management. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Asgar AW, Ducharme A, Pellerin M, Garceau P, Basmadjian A, Bouchard D, Bonan R. The Evolution of Transcatheter Therapies for Mitral Valve Disease: From Mitral Valvuloplasty to Transcatheter Mitral Valve Replacement. Can J Cardiol 2022; 38:S54-S65. [PMID: 33383168 DOI: 10.1016/j.cjca.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022] Open
Abstract
The prevalence of mitral valve disease has evolved over the past 5 decades from primarily a disease of rheumatic origin to a disease affecting the aging population that encompasses a range of phenotypes from rheumatic mitral stenosis, degenerative mitral regurgitation, and degenerative mitral valve calcification to secondary mitral regurgitation. A reflection on the history of therapy for mitral valve disease is an expedition that follows the birth and development of structural heart intervention from the first percutaneous balloon mitral valvuloplasty to innovative technologies for transcatheter mitral valve repair and replacement. This review will lead you along this journey, pause to acknowledge the feats accomplished, and reflect on the road that lies ahead.
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Affiliation(s)
- Anita W Asgar
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada.
| | - Anique Ducharme
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Michel Pellerin
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Patrick Garceau
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Arsène Basmadjian
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Denis Bouchard
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Raoul Bonan
- Department of Cardiology, Montreal Heart Institute, Montreal, Quebec, Canada
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18
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Milwidsky A, Mathai SV, Topilsky Y, Jorde UP. Medical Therapy for Functional Mitral Regurgitation. Circ Heart Fail 2022; 15:e009689. [PMID: 35862021 DOI: 10.1161/circheartfailure.122.009689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional mitral regurgitation (FMR) can be broadly categorized into 2 main groups: ventricular and atrial, which often coexist. The former is secondary to left ventricular remodeling usually in the setting of heart failure with reduced ejection fraction or less frequently due to ischemic papillary muscle remodeling. Atrial FMR develops due to atrial and annular dilatation related to atrial fibrillation/flutter or from increased atrial pressures in the setting of heart failure with preserved ejection fraction. Guideline-directed medical therapy is the first step and prevails as the mainstay in the treatment of FMR. In this review, we address the medical therapeutic options for FMR management and highlight a targeted approach for each FMR category. We further address important clinical and echocardiographic characteristics to aid in determining when medical therapy is expected to have a low yield and an appropriate window for effective interventional approaches exists.
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Affiliation(s)
- Assi Milwidsky
- Department of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (A.M., U.P.J.).,Department of Cardiology, Tel-Aviv Sourasky Medical Center (affiliated with the Sackler School of Medicine), Tel-Aviv University, Israel (A.M., Y.T.)
| | - Sheetal Vasundara Mathai
- Department of Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, NY (S.V.M.)
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center (affiliated with the Sackler School of Medicine), Tel-Aviv University, Israel (A.M., Y.T.)
| | - Ulrich P Jorde
- Department of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (A.M., U.P.J.)
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19
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Leurent G, Auffret V, Donal E, Corbineau H, Grinberg D, Bonnet G, Leroux PY, Guérin P, Wautot F, Lefèvre T, Messika-Zeitoun D, Iung B, Armoiry X, Trochu JN, Boutitie F, Obadia JF. Delayed hospitalisation for heart failure after transcatheter repair or medical treatment for secondary mitral regurgitation: a landmark analysis of the MITRA-FR trial. EUROINTERVENTION 2022; 18:514-523. [PMID: 35611516 PMCID: PMC10241268 DOI: 10.4244/eij-d-21-00846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the MITRA-FR trial, transcatheter mitral valve repair (TMVR) was not associated with a 2-year clinical benefit in patients with secondary mitral regurgitation (SMR). AIMS This landmark analysis aimed at investigating a potential reduction of the hospitalisation rate for heart failure (HF) between 12 and 24 months after inclusion in the MITRA-FR trial in patients randomised to the intervention group (TMVR with the MitraClip device), as compared with patients randomised to the control group (guideline-directed medical therapy [GDMT]). METHODS The MITRA-FR trial randomised 307 patients with SMR for TMVR on top of GDMT (TMVR group; n=152) or for GDMT alone (control group; n=155). We conducted a 12-month landmark analysis in surviving patients who were not hospitalised for HF within the first 12 months of follow-up. The primary endpoint was the 1-year cumulative number of HF hospitalisations. RESULTS A total of 140 patients (TMVR group: 67; GDMT group: 73) were selected for this landmark analysis with similar characteristics at inclusion in the trial. The primary endpoint was 28 events per 100 patient-years in the TMVR group, as compared with 60 events per 100 patient-years in the GDMT group (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.20-1.02; p=0.057). CONCLUSIONS In this landmark analysis of the MITRA-FR trial, the cumulative rate of HF hospitalisation between 12 and 24 months among patients treated with TMVR on top of GDMT was approximately half as many as those of patients treated with GDMT alone, a difference which did not reach statistical significance in the setting of a low number of events.
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Affiliation(s)
- Guillaume Leurent
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Vincent Auffret
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Erwan Donal
- Université de Rennes, CHU Rennes, INSERM, LTSI - UMR 1099, Rennes, France
- Service de Cardiologie, CHU Rennes, Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, CHU Rennes, Rennes, France
| | - Daniel Grinberg
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France and Aix-Marseille Université, INSERM, Marseille, France
| | - Pierre-Yves Leroux
- Cardiologie Médicale et Structurelle, Médipôle Lyon-Villeurbanne, France
| | - Patrice Guérin
- Université Nantes, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Bernard Iung
- Hôpital Bichat - Claude Bernard, DHU FIRE, Paris, France and Université de Paris and INSERM 1148, Paris, France
| | - Xavier Armoiry
- Pharmacy Department, University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Lyon, France
- University of Warwick, Warwick Medical School, Coventry, United Kingdom
| | - Jean-Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Florent Boutitie
- Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon; and Université Lyon 1, Villeurbanne, France; and CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
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20
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Marwick TH, Chandrashekhar Y. Quantification and Selective Use of Multimodality Imaging in the Assessment of Valvular Regurgitation. JACC Cardiovasc Imaging 2022; 15:957-959. [PMID: 35512965 DOI: 10.1016/j.jcmg.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [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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22
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Transcatheter Mitral Valve Repair in Disproportionate Secondary Mitral Regurgitation. Can J Cardiol 2022; 38:1300-1303. [DOI: 10.1016/j.cjca.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
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23
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Cimino S, Agati L, Filomena D, Maestrini V, Monosilio S, Birtolo LI, Mocci M, Mancone M, Sardella G, Grayburn P, Fedele F. 3D Echo Characterization of Proportionate and Disproportionate Functional Mitral Regurgitation before and after Percutaneous Mitral Valve Repair. J Clin Med 2022; 11:645. [PMID: 35160100 PMCID: PMC8836818 DOI: 10.3390/jcm11030645] [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: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of percutaneous mitral valve repair (PMVr) on long-term prognosis in patients with functional mitral regurgitation (FMR) is still unclear. Recently, a new conceptual framework classifying FMR as proportionate (P-MR) and disproportionate (D-MR) was proposed, according to the effective regurgitant orifice area/left ventricular end-diastolic volume (EROA/LVEDV) ratio. The aim was to assess its possible influence on PMVr efficacy. METHODS A total of 56 patients were enrolled. MV annulus, LV volumes and function were assessed. Global longitudinal strain (GLS) was also calculated. Patients were divided into two groups, according to the EROA/LVEDV ratio. Echocardiographic follow-up was performed after 6 months, and adverse events were collected after 12 months. RESULTS D-MR patients (n = 28, 50%) had a significantly more elliptical MV annulus (p = 0.048), lower tenting volume (p = 0.01), higher LV ejection fraction (LVEF: 32 ± 7 vs. 26 ± 5%, p = 0.003), lower LVEDV, LV end-systolic volume (LVESV) and mass (LVEDV/i: 80 ± 20 vs. 126 ± 27 mL, p = 0.001; LVESV/i: 60 ± 20 vs. 94 ± 23 mL, p < 0.001; LV mass: 249 ± 63 vs. 301 ± 69 gr, p = 0.035). GLS was more impaired in P-MR (p = 0.048). After 6 months, P-MR patients showed a higher rate of MR recurrence. After 12 months, the rate of CV death and rehospitalization due to HF was significantly higher in P-MR patients (46% vs. 7%, p < 0.001). P-MR status was strongly associated with CV death/rehospitalization (HR = 3.4, CI 95% = 1.3-8.6, p = 0.009). CONCLUSIONS Patients with P-MR seem to have worse outcomes after PVMr than D-MR patients. Our study confirms the importance of the EROA/LVEDV ratio in defining different subsets of FMR based on the anatomical characteristic of MV and LV.
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Affiliation(s)
- Sara Cimino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Michele Mocci
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Paul Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX 75246, USA;
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
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Baumgartner H, Iung B, Messika-Zeitoun D, Otto CM. The year in cardiovascular medicine 2021: valvular heart disease. Eur Heart J 2022; 43:633-640. [PMID: 34974619 DOI: 10.1093/eurheartj/ehab885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 12/23/2021] [Indexed: 12/27/2022] Open
Affiliation(s)
- Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster 48149, Germany
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, APHP, Université de Paris, Paris, France
| | | | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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26
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Berrill M, Beeton I, Fluck D, John I, Lazariashvili O, Stewart J, Ashcroft E, Belsey J, Sharma P, Baltabaeva A. Disproportionate Mitral Regurgitation Determines Survival in Acute Heart Failure. Front Cardiovasc Med 2021; 8:742224. [PMID: 34926604 PMCID: PMC8675886 DOI: 10.3389/fcvm.2021.742224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: To assess the prevalence and impact of mitral regurgitation (MR) on survival in patients presenting to hospital in acute heart failure (AHF) using traditional echocardiographic assessment alongside more novel indices of proportionality. Background: It remains unclear if the severity of MR plays a significant role in determining outcomes in AHF. There is also uncertainty as to the clinical relevance of indexing MR to left ventricular volumes. This concept of disproportionality has not been assessed in AHF. Methods: A total of 418 consecutive patients presenting in AHF over 12 months were recruited and followed up for 2 years. MR was quantitatively assessed within 24 h of recruitment. Standard proximal isovelocity surface area (PISA) and a novel proportionality index of effective regurgitant orifice/left ventricular end-diastolic volume (ERO/LVEDV) >0.14 mm2/ml were used to identify severe and disproportionate MR. Results: Every patient had MR. About 331/418 (78.9%) patients were quantifiable by PISA. About 165/418 (39.5%) patients displayed significant MR. A larger cohort displayed disproportionate MR defined by either a proportionality index using ERO/LVEDV > 0.14 mm2/ml or regurgitant volumes/LVEDV > 0.2 [217/331 (65.6%) and 222/345 (64.3%), respectively]. The LVEDV was enlarged in significant MR−129.5 ± 58.95 vs. 100.0 ± 49.91 ml in mild, [p < 0.0001], but remained within the normal range. Significant MR was associated with a greater mortality at 2 years {44.2 vs. 34.8% in mild MR [hazard ratio (HR) 1.39; 95% CI: 1.01–1.92, p = 0.04]}, which persisted with adjustment for comorbid conditions (HR; 1.43; 95% CI: 1.04–1.97, p = 0.03). Disproportionate MR defined by ERO/LVEDV >0.14 mm2/ml was also associated with worse outcome [42.4 vs. 28.3% (HR 1.62; 95% CI 1.12–2.34, p = 0.01)]. Conclusions: MR was a universal feature in AHF and determines outcome in significant cases. Furthermore, disproportionate MR, defined either by effective regurgitant orifice (ERO) or volumetrically, is associated with a worse prognosis despite the absence of adverse left ventricular (LV) remodeling. These findings outline the importance of adjusting acute volume overload to LV volumes and call for a review of the current standards of MR assessment. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT02728739, identifier NCT02728739.
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Affiliation(s)
- Max Berrill
- Department of Cardiology, St. Peter's Hospital, Surrey, United Kingdom
| | - Ian Beeton
- Department of Cardiology, St. Peter's Hospital, Surrey, United Kingdom
| | - David Fluck
- Department of Cardiology, St. Peter's Hospital, Surrey, United Kingdom.,Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | - Isaac John
- Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | - Otar Lazariashvili
- Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | - Jack Stewart
- Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | - Eshan Ashcroft
- Department of Cardiology, St. Peter's Hospital, Surrey, United Kingdom.,Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | | | - Pankaj Sharma
- Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom
| | - Aigul Baltabaeva
- Department of Cardiology, St. Peter's Hospital, Surrey, United Kingdom.,Department of Research and Development, St. Peter's Hospital, Surrey, United Kingdom.,Institute of Cardiovascular Research, Royal Holloway University, University of London, Egham, United Kingdom.,Department of Cardiology, Royal Brompton and Harefield Hospital, London, United Kingdom
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27
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Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair. J Am Coll Cardiol 2021; 78:2408-2421. [PMID: 34886961 DOI: 10.1016/j.jacc.2021.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although mitral valve transcatheter edge-to-edge repair (M-TEER) achieves symptomatic benefit for a broad spectrum of patients with relevant secondary mitral regurgitation, conflicting data exist on its prognostic impact. OBJECTIVES Adapted enrollment criteria approaching those used in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) and MITRA-FR (Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation) trials were retrospectively applied to a European real-world registry to evaluate the influence of the respective criteria on outcomes. METHODS A total of 1,022 patients included in the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry and treated with M-TEER (November 2008 to September 2019) were stratified into COAPT-eligible (n = 353 [34.5%]) and COAPT-ineligible (n = 669 [65.5%]) as well as MITRA-FR-eligible (n = 408 [48.3%]) and MITRA-FR-ineligible (n = 437 [51.7%]) groups. RESULTS Although the stratification of patients according to adapted MITRA-FR criteria led to comparable outcomes regarding all-cause mortality (P = 0.19), the application of adapted COAPT enrollment criteria demonstrated lower mortality rates in COAPT-eligible compared with COAPT-ineligible patients (P < 0.001). Multivariable Cox regression analysis identified New York Heart Association functional class IV (hazard ratio [HR]: 2.29; 95% confidence interval [CI]: 1.53-3.42; P < 0.001), logarithmic N-terminal pro-brain natriuretic peptide (HR: 1.47; 95% CI: 1.24-1.75; P < 0.001), and right ventricular-to-pulmonary arterial coupling (HR: 0.10; 95% CI: 0.02-0.57; P = 0.009) as independent predictors of outcome. Yet improvement of functional outcome was demonstrated in a subset of patients irrespective of COAPT eligibility status. CONCLUSIONS In this real-world cohort of patients with secondary mitral regurgitation undergoing M-TEER, the retrospective application of adapted COAPT enrollment criteria successfully identified a specific phenotype demonstrating lower mortality rates. On the contrary, stratification according to adapted MITRA-FR criteria resulted in comparable outcomes.
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28
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Mizote I, Nakamura D. Who Benefits From the MitraClip? Circ J 2021; 86:412-414. [PMID: 34866124 DOI: 10.1253/circj.cj-21-0924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisuke Nakamura
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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29
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Saia F. Transcatheter edge-to-edge mitral valve repair: Should we stay tied to COAPT tiers? Catheter Cardiovasc Interv 2021; 98:1413-1414. [PMID: 34851027 DOI: 10.1002/ccd.29989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS University Hospital of Bologna, Bologna, Italy
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30
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MitraClip implantation in real-world: clinical relevance of different patterns of left ventricular remodeling. Hellenic J Cardiol 2021; 64:7-14. [PMID: 34843994 DOI: 10.1016/j.hjc.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/25/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The role of left ventricular (LV) volumes and ejection fraction (EF) in the selection of patients candidates to MitraClip procedure remains matter of debate. To assess the pattern of LV remodeling and its clinical implications after MitraClip procedures, and to evaluate the role of LV ejection fraction (EF) in patient selection. METHODS Complete echocardiography was performed before, at discharge,1,6, and 12-month in 45 patients treated with MitraClip for severe mitral regurgitation (MR) [age 78.2±8.3 yrs, NYHA 3.74±0.44, EF 36.5±12.8%]. From baseline to 6-month reverse and adverse LV-R was defined as ≥15 % decrease and ≥10% increase in LV end-systolic volume, respectively. RESULTS At 6-month, sustained reduction of MR≤2 was observed in all patients, but 2; reverse, adverse and no LV-R occurred in 51% (N=23), 18% (N=8) and 31% (N=14) patients. Baseline LV end-diastolic volume was an independent predictor of reverse LV-R [P=0.004], whereas EF was not. During follow-up (17.5±9.3 months), freedom from the composite endpoint (mortality and hospitalization for heart failure) was observed in 50% of adverse/no LV-R vs. 95.7% of reverse LV-R patients (P=0.006). At Cox analysis, adverse LV-R and adverse/no LV-R were associated with composite endpoint with adjusted hazard ratio of 5.6 (95% CI 1.65-19.00) and 10.08 (95% CI 1.29-78.6), respectively. CONCLUSIONS After MitraClip implantation, sustained adverse or no LV-R occurred in one-in-two patients and was associated with poor prognosis. Large LV volumes may help us to avoid futility of procedure.
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31
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Percutaneous mitral valve repair in severe secondary mitral regurgitation: Analysis of index hospitalization and economic evaluation based on the MITRA-FR trial. Arch Cardiovasc Dis 2021; 114:805-813. [PMID: 34802961 DOI: 10.1016/j.acvd.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/30/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Percutaneous mitral valve repair (pMVR) is reimbursed in France for severe secondary mitral regurgitation (SMR), but French data regarding the hospitalization index stay are lacking. AIMS Our objectives were to describe the index hospitalization stay and to evaluate the cost of hospital stay for pMVR used in SMR. METHODS A secondary evaluation based on patients who were randomized to the intervention group of the MITRA-FR study was undertaken. The economic evaluation was conducted according to the French hospital perspective. Medical resource use was estimated using specific data collected from patients enrolled in the MITRA-FR study and non-specific data from national statistics. RESULTS The population was represented by 144 patients who underwent pMVR at 33 French centres. There was a mean±standard deviation of 7.9±1.5 hospital staff during procedures. The mean procedure duration was 154±68 minutes and increased with the number of implanted clips. Median total length of stay was 8 days. The occurrence of a serious adverse event was not associated with an increased risk of admission to the critical care unit, but was associated with an increased length of stay. The mean total cost was 28,025±3424€, which includes 21,547€ for the cost of medical devices used during pMVR and 6478±3424€ for other costs. CONCLUSION The cost of pMVR is substantial for patients with SMR, which advocates for further efforts to identify the patients with SMR who are likely to derive a clear clinical benefit from the procedure.
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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33
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2252] [Impact Index Per Article: 750.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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35
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Ooms JF, Bouwmeester S, Debonnaire P, Nasser R, Voigt JU, Schotborgh MA, Geleijnse ML, Kardys I, Spitzer E, Daemen J, De Jaegere PP, Houthuizen P, Swaans MJ, Dubois C, Claeys M, Van Der Heyden J, Tonino PA, Van Mieghem NM. Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation. J Am Soc Echocardiogr 2021; 35:105-115.e8. [PMID: 34389469 DOI: 10.1016/j.echo.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). METHODS This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. RESULTS Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30% (interquartile range [IQR], 25%-35%), 27 mm2, and 107 mL/m2 (IQR, 90-135 mL/m2), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10-0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32% [IQR, 27%-39%] vs 26% [IQR, 22%-33%]; P < .01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95% CI, 0.28-0.74; P < .01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95% CI, 0.53-1.63; P = .80). Overall, in 35% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30% (n = 66) and 37% (n = 76), with no differences between dFMR and pFMR. CONCLUSIONS TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders.
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Affiliation(s)
- Joris F Ooms
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Riwa Nasser
- University Hospital Antwerp, Antwerp, Belgium
| | | | | | - Marcel L Geleijnse
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ernest Spitzer
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P De Jaegere
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | - Marc Claeys
- University Hospital Antwerp, Antwerp, Belgium
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Landi A, Faletra FF, Pavon AG, Pedrazzini G, Valgimigli M. From secondary to tertiary mitral regurgitation: the paradigm shifts, but uncertainties remain. Eur Heart J Cardiovasc Imaging 2021; 22:835-843. [PMID: 33982052 DOI: 10.1093/ehjci/jeab080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/16/2021] [Indexed: 12/27/2022] Open
Abstract
Secondary mitral regurgitation (MR) is the most common and undertreated form of MR, whose contribution to poor prognosis and indications to correction remains under discussion. MR has been characterized into 'proportionate' or 'disproportionate', based on left ventricle (LV) and regurgitant volumes, whereas 'tertiary' MR identifies conditions, in which regurgitation is pathologic per se and actively contributes to LV dysfunction. Echocardiographic and anatomo-pathological studies revealed that secondary MR prompts subtle leaflet maladaptive changes, actively contributing to the dynamic progression of secondary MR. We critically discuss the paradigm shift from secondary to tertiary MR and question the notion that MV leaflets play a passive role in secondary MR. We also review the role of standard transthoracic echocardiography for appraising and quantifying maladaptive MV leaflet changes and LV volumes and call for a more sophisticated and comprehensive imaging framework for classifying MR in future interventional studies.
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Affiliation(s)
- Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Fulvio Faletra
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Anna Giulia Pavon
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Giovanni Pedrazzini
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.,Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Marco Valgimigli
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
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37
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Hahn RT. Treatment Goals for Transcatheter Edge-to-Edge Mitral Valve Repair: Are Optimal Results Always Optimum? JACC Cardiovasc Interv 2021; 14:1254-1256. [PMID: 33992548 DOI: 10.1016/j.jcin.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York, USA.
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38
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Coats AJS, Anker SD, Baumbach A, Alfieri O, von Bardeleben RS, Bauersachs J, Bax JJ, Boveda S, Čelutkienė J, Cleland JG, Dagres N, Deneke T, Farmakis D, Filippatos G, Hausleiter J, Hindricks G, Jankowska EA, Lainscak M, Leclercq C, Lund LH, McDonagh T, Mehra MR, Metra M, Mewton N, Mueller C, Mullens W, Muneretto C, Obadia JF, Ponikowski P, Praz F, Rudolph V, Ruschitzka F, Vahanian A, Windecker S, Zamorano JL, Edvardsen T, Heidbuchel H, Seferovic PM, Prendergast B. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J 2021; 42:1254-1269. [PMID: 33734354 PMCID: PMC8014526 DOI: 10.1093/eurheartj/ehab086] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology-the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)-presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology (CVK), Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany.,Charité Universitätsmedizin Berlin, Germany
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Yale University School of Medicine, New Haven, USA
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania
| | - John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christoph Leclercq
- Université de Rennes I, CICIT 804, Rennes, CHU Pontchaillou, France, Rennes
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mandeep R Mehra
- Brigham Women's Hospital Heart and Vascular Center and the Center of Advanced Heart Disease, Harvard Medical School, Boston, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel, Centre d'Investigation Clinique, Filière Insuffisance Cardiaqu, e, France, Lyon
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Frank Ruschitzka
- Cardiology Clinic, University Heart Center, University Hospital Zürich, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.,University Alcala, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | | | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
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39
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Izumi C. Perspectives of managements of valvular heart diseases in transcatheter intervention era: What should we discuss from the guidelines? Asian Cardiovasc Thorac Ann 2021; 29:247-249. [PMID: 33653151 DOI: 10.1177/0218492321998943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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40
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Bermejo J, Postigo A, Baumgartner H. The year in cardiovascular medicine 2020: valvular heart disease. Eur Heart J 2021; 42:647-656. [PMID: 33388778 PMCID: PMC7878012 DOI: 10.1093/eurheartj/ehaa1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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41
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Abstract
Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two recent randomized clinical trials generated apparently controversial results but actually provided an interesting pathophysiologic frame that could help discerning patients who will benefit from the procedure versus patients who will not. In this review, we will discuss current treatment options for mitral regurgitation, focusing on percutaneous mitral valve repair with the MitraClip system.
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42
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Flachskampf FA, Grayburn PA. Who Benefits From Transcatheter Edge-To-Edge Mitral Valve Repair and Who Does Not: The Enigma Continues. JACC Cardiovasc Imaging 2020; 14:753-755. [PMID: 33011126 DOI: 10.1016/j.jcmg.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden.
| | - Paul A Grayburn
- Department of Medicine, Baylor Scott and White Heart and Vascular Hospital, Plano, Texas, USA
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