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Hu C, Ge Z, Li W, Pan W, Ge Z, Zhao W, Kong D, Zhou D, Wei L, Shu X, Pan C, Ge J. 2-year results and myocardial impact of transapical mitral valve repair in patients with primary mitral regurgitation: an echocardiographic study. J Cardiothorac Surg 2024; 19:403. [PMID: 38943166 PMCID: PMC11212359 DOI: 10.1186/s13019-024-02827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND There is limited data on the 2-year outcomes of transapical transcatheter edge-to-edge repair (TA-TEER) using the ValveClamp in patients with severe primary mitral regurgitation (MR) and its impact on myocardial deformation. METHODS From July 2018 to March 2021, 53 patients with symptomatic severe primary MR underwent TA-TEER were enrolled. The endpoint was the composite of all-cause mortality, recurrent 3 + or 4 + MR, or need for mitral surgery. RESULTS Among the 53 patients who had successfully ValveClamp implantation, 8(15.1%) reached the composite endpoint. Significant improvement in left ventricular (LV) end-diastolic volume, pulmonary artery systolic pressure, NYHA functional class, and MR severity were observed (P < 0.05 for all). Univariate Cox's regression analysis revealed that LV end-diastolic volume index, LV end-systolic volume index, left atrial volume index, and pulmonary artery systolic pressure were associated with adverse events (P < 0.05 for all). On multivariate Cox regression analysis, left atrial volume index was independently associated with the endpoint (hazard ratio, 1.049; 95% CI, 1.009-1.091; P < 0.001) after adjustment for above echocardiographic parameters. LV global longitudinal strain and apical longitudinal strain in global and regional segments decreased at 30 days, but showed a recovery at 2 years with no significant difference compared to the baseline. CONCLUSION TA-TEER using the ValveClamp presented favorable safety and efficacy at 2-year. Myocardial deformation impairment was observed at 30 days post-procedure, but did not persist at 2 years.
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Affiliation(s)
- Chunqiang Hu
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Zhenyi Ge
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Wei Li
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Zhengdan Ge
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Weipeng Zhao
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Lai Wei
- Department of Echocardiography, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Shanghai, China
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Wang C, Yang W, Shi Z, Fang Y. Renal function improvement correlates with 3D echocardiographic findings: Effect of surgical mitral valve repair. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:385-393. [PMID: 38344863 DOI: 10.1002/jcu.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The association between surgical treatment of mitral regurgitation (MR) and renal function is not sufficiently well-known. We tried to evaluate renal function before and after the procedure of surgical mitral valve repair (SMVR) in degenerative severe MR. METHODS Patients with primary severe (4+) MR and normal left ventricular ejection fraction (LVEF) that underwent SMVR, examined by a cutting-edge 3-dimensional (3D) echocardiographic probe were enrolled in this study. We took three CKD-EPI equations to measure estimated glomerular filtration rate (eGFR) before SMVR and shortly before patients discharge. A total of 40 patients with baseline lower mean eGFR were evaluated. RESULTS Measurements substantiated statistically significant improvements in eGFR (p < 0.001), multivariable linear regression modeling indicating prominent associations between increase in eGFR and decrease of MR (p = 0.003), decline of pulmonary arterial systolic pressure (p = 0.018), as well as increment of forward stroke volume (p = 0.02), in spite of LVEF reduction, left ventricular global longitudinal strain worsening and left atrial ejection fraction impairment. CONCLUSIONS Renal function improves after SMVR in patients with degenerative significant MR and preserved LVEF, regardless of cardiac functional worsening.
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Affiliation(s)
- Chenchen Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbo Yang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongwei Shi
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Fang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Powers A, Lavoie N, Le Nezet E, Clavel MA. Unique Aspects of Women's Valvular Heart Diseases: Impact for Diagnosis and Treatment. CJC Open 2024; 6:503-516. [PMID: 38487043 PMCID: PMC10935694 DOI: 10.1016/j.cjco.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/15/2023] [Indexed: 03/17/2024] Open
Abstract
Valvular heart diseases (VHDs) are a major cause of cardiovascular morbidity and mortality worldwide. As degenerative and functional mechanisms represent the main etiologies in high-income countries are degenerative and functional, while in low income countries etiologie is mostly rheumatic. Although therapeutic options have evolved considerably in recent years, women are consistently diagnosed at later stages of their disease, are delayed in receiving surgical referrals, and exhibit worse postoperative outcomes, compared to men. This difference is a result of the historical underrepresentation of women in studies from which current guidelines were developed. However, in recent years, important research, including more female patients, has been conducted and has highlighted substantial sex-specific differences in the etiology, diagnosis, and treatment of VHDs. Systematic consideration of these sex-specific differences in VHD patients is crucial for providing equitable healthcare and optimizing clinical outcomes in both female and male patients. Hence, this review aims to explore implications of sex-specific particularities for diagnosis, treatment options, and outcomes in women with VHDs.
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Affiliation(s)
- Andréanne Powers
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Nicolas Lavoie
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Emma Le Nezet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
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Sakata T, Mazurek R, Mavropoulos SA, Romeo F, Ravichandran AJ, Watanabe S, Kariya T, Ishikawa K. Left Atrial Remodeling and Dysfunction in Swine Models of Mitral Regurgitation. Am J Physiol Heart Circ Physiol 2022; 322:H914-H923. [PMID: 35333115 DOI: 10.1152/ajpheart.00009.2022] [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: 11/22/2022]
Abstract
BACKGROUND Left atrial (LA) dysfunction is one of the predictive factors of worse outcomes after mitral valve surgery for mitral regurgitation (MR). We aimed to investigate the effect of MR etiology on progression of LA remodeling in swine MR models. METHODS MR was induced in 14 Yorkshire pigs using catheter-based procedures. Seven pigs underwent simultaneous occlusions of the left circumflex artery and the diagonal branch, which resulted in ischemic MR (IMR group). The other seven pigs underwent chordal severing to induce leaflet prolapse simulating degenerative MR (DMR group). Changes in LA volume and function were assessed at baseline, 1 and 3 months using echocardiography and hemodynamic evaluations. Histopathological assessments were conducted to evaluate LA hypertrophy and fibrosis. RESULTS At 3 months, quantitative MR severity was comparable and severe in both groups. Despite the similar degree of MR, minimum LA volume index increased significantly more in the IMR group (IMR: 11.9±6.4 to 73.2±6.4, DMR: 10.7±6.4 to 29.5±6.4 ml/m2, pinteraction=0.004). Meanwhile, increase in maximum LA volume index was similar between the groups, resulting in lower LA emptying function in the IMR group (IMR: 60.1±3.1 to 29.4±3.1, DMR: 62.4±3.1 to 58.2±3.1%, pinteraction=0.0003). LA reservoir strain assessed by echocardiography was also significantly lower in the IMR group. Histological analyses revealed increased LA cellular hypertrophy and fibrosis in the IMR group. CONCLUSIONS Ischemic MR is associated with aggressive remodeling and reduced emptying function compared to MR due to leaflet prolapse. Earlier intervention might be necessary for ischemic MR to prevent LA remodeling.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Renata Mazurek
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Spyros A Mavropoulos
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Francisco Romeo
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anjali J Ravichandran
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shin Watanabe
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Taro Kariya
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kiyotake Ishikawa
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Hagendorff A, Knebel F, Helfen A, Stöbe S, Haghi D, Ruf T, Lavall D, Knierim J, Altiok E, Brandt R, Merke N, Ewen S. Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness. Clin Res Cardiol 2021; 110:1704-1733. [PMID: 33839933 PMCID: PMC8563569 DOI: 10.1007/s00392-021-01841-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/08/2021] [Indexed: 12/28/2022]
Abstract
The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité Universitätsmedizin Berlin, Campus Mitte, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Helfen
- Department of Cardiology, Katholisches Klinikum Lünen Werne GmbH, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - Stephan Stöbe
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dariush Haghi
- Kardiologische Praxisklinik Ludwigshafen, Akademische Lehrpraxis der Universität Mannheim, Ludwig-Guttmann-Strasse 11, 67071, Ludwigshafen, Germany
| | - Tobias Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Daniel Lavall
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Ertunc Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Roland Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str, IMED, 66421, Homburg, Germany
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Lehr EJ, Petrescu OM. Asymptomatic But Not Always Benign: New Insights Into Severe Mitral Regurgitation. Ann Thorac Surg 2020; 111:870-871. [PMID: 33058826 DOI: 10.1016/j.athoracsur.2020.07.062] [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: 07/02/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Eric J Lehr
- Division of Cardiac Surgery, Swedish Heart & Vascular Institute, 1600 E Jefferson St, Ste 110, Seattle, WA 98122.
| | - O Madalina Petrescu
- Division of Cardiology, Swedish Heart & Vascular Institute, Seattle, Washington
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Tsai FC, Chang GJ, Lai YJ, Chang SH, Chen WJ, Yeh YH. Ubiquitin Pathway Is Associated with Worsening Left Ventricle Function after Mitral Valve Repair: A Global Gene Expression Study. Int J Mol Sci 2020; 21:ijms21145073. [PMID: 32708358 PMCID: PMC7404186 DOI: 10.3390/ijms21145073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
The molecular mechanism for worsening left ventricular (LV) function after mitral valve (MV) repair for chronic mitral regurgitation remains unknown. We wished to assess the LV transcriptome and identify determinants associated with worsening LV function post-MV repair. A total of 13 patients who underwent MV repair for chronic primary mitral regurgitation were divided into two groups, preserved LV function (N = 8) and worsening LV function (N = 5), for the study. Specimens of LV from the patients taken during surgery were used for the gene microarray study. Cardiomyocyte cell line HL-1 cells were transfected with gene-containing plasmids and further evaluated for mRNA and protein expression, apoptosis, and contractile protein degradation. Of 67,258 expressed sequence tags, microarrays identified 718 genes to be differentially expressed between preserved-LVF and worsening-LVF, including genes related to the protein ubiquitination pathway, bone morphogenetic protein (BMP) receptors, and regulation of eIF4 and p70S6K signaling. In addition, worsening-LVF was associated with altered expressions of genes pathologically relevant to heart failure, such asdownregulated apelin receptors and upregulated peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PPARGC1A). HL-1 cardiomyocyte cells transfected with ubiquitination-related genes demonstrated activation of the protein ubiquitination pathwaywith an increase in the ubiquitin activating enzyme E1 (UAE-E1). It also led to increased apoptosis, downregulated and ubiquitinated X-linked inhibitor of apoptosis protein (XIAP), and reduced cell viability. Overexpression of ubiquitination-related genes also resulted in degradation and increased ubiquitination of α-smooth muscle actin (SMA). In conclusion, worsening-LVF presented differential gene expression profiles from preserved-LVF after MV repair. Upregulation of protein ubiquitination-related genes associated with worsening-LVF after MV repair may exert adverse effects on LV through increased apoptosis and contractile protein degradation.
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Affiliation(s)
- Feng-Chun Tsai
- Division of Cardiovascular and Thoracic Surgery, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan;
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Taoyuan 333, Taiwan;
| | - Ying-Ju Lai
- Department of Respiratory Therapy, Chang-Gung University College of Medicine, Taoyuan 333, Taiwan;
| | - Shang-Hung Chang
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wei-Jan Chen
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yung-Hsin Yeh
- College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan; (S.-H.C.); (W.-J.C.)
- Cardiovascular Department, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: ; Tel./Fax: +886-3-3271192
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Fryer ML, Balsam LB. Commentary: At the heart of the matter-Left atrial volume index in chronic mitral regurgitation. J Thorac Cardiovasc Surg 2019; 160:673-674. [PMID: 31635862 DOI: 10.1016/j.jtcvs.2019.08.059] [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: 08/21/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Leora B Balsam
- Division of Cardiac Surgery, UMass Memorial Medical Center, Worcester, Mass.
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