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Yin H, Ma L, Zhou Y, Tang X, Li R, Zhou Y, Shi J, Zhang J. Efficacy of early administration of sacubitril/valsartan after coronary artery revascularization in patients with acute myocardial infarction complicated by moderate-to-severe mitral regurgitation: a randomized controlled trial. Heart Vessels 2024; 39:673-686. [PMID: 38635062 DOI: 10.1007/s00380-024-02398-2] [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: 10/22/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Effects of angiotensin receptor/neprilysin inhibitors (ARNI) on ventricular remodeling in patients with heart failure, especially heart failure with reduced ejection fraction (HFrEF), are better than those of angiotensin-converting enzyme inhibitors (ACEI). Acute myocardial infarction (AMI) complicated by mitral regurgitation exacerbates ventricular remodeling and increases the risk of heart failure. There is limited evidence on the effects of early administration of ARNI in patients with AMI complicated by mitral regurgitation. The aim of this trial was to examine the effectiveness and the safety of early administration of sacubitril/valsartan after coronary artery revascularization in patients with AMI complicated by moderate-to-severe mitral regurgitation. This was a randomized, single-blind, parallel-group, controlled trial. From June 2021 to June 2022, we enrolled 142 consecutive patients with AMI complicated by moderate-to-severe mitral regurgitation and followed them for 12 months. The patients received standard treatment for AMI and were randomly assigned to receive ARNI or benazepril. The primary efficacy end points were the differences in mitral regurgitant jet area (MRJA), mitral regurgitant volume (MRV), concentration of n-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume and end-systolic volume (LVEDV and LVESV) between groups and within groups at baseline, 1, 3, 6, and 12 months. Secondary end points included the rates of heart failure hospitalization, all-cause mortality, refractory angina, malignant arrhythmias, recurrent myocardial infarction, and stroke. Safety end points included the rates of hyperkalemia, renal dysfunction, hypotension, angioedema, and cough. The ARNI group had significantly lower NT-proBNP levels than the benazepril group at 1 month and later (P < 0.001). MRJA and MRV significantly improved in the ARNI group compared with the benazepril group at 12 months (MRJA: - 3.21 ± 2.18 cm2 vs. - 1.83 ± 2.81 cm2, P < 0.05; MRV: - 27.22 ± 15.22 mL vs. - 13.67 ± 21.02 mL, P < 0.001). The ARNI group also showed significant reductions in LVEDV and LVESV (P < 0.05) and improvement in LVEF (P < 0.05). Secondary end point analysis showed a significantly higher rate of heart failure hospitalization in the benazepril group compared with the ARNI group (HR = 2.03, 95% CI 1.12-3.68, P = 0.021). Safety end point analysis showed a higher rate of hypotension in the ARNI group (P < 0.05). Early use of sacubitril/valsartan after coronary artery revascularization in patients with AMI complicated by moderate-to-severe mitral regurgitation can significantly reduce mitral regurgitation, improve ventricular remodeling, and decrease heart failure hospitalization. Nevertheless, caution is needed to avoid hypotension. Chinese Clinical Trial Registry (ChiCTR2100054255) registered on December 11, 2021.
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Affiliation(s)
- Hongtao Yin
- Tianjin Medical University, Tianjin, 300000, People's Republic of China
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Lixiang Ma
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Yanqing Zhou
- The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Xiuying Tang
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Runjun Li
- Department of Critical Care Medicine, People's Hospital of Yangjiang, Yangjiang, Guangdong, 529500, People's Republic of China
| | - Yingjun Zhou
- Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Jiaxiu Shi
- The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, 066000, People's Republic of China
| | - Jun Zhang
- Tianjin Medical University, Tianjin, 300000, People's Republic of China.
- Depatment of Cardiology, Cangzhou Central Hospital, Tianjin Medical University Teaching Hospital, Cangzhou, Hebei, 061000, People's Republic of China.
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2
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Broncano J, Hanneman K, Ghoshhajra B, Rajiah PS. Cardiac Computed Tomography of Native Cardiac Valves. Radiol Clin North Am 2024; 62:399-417. [PMID: 38553177 DOI: 10.1016/j.rcl.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Valvular heart disease (VHD) is a significant clinical problem associated with high morbidity and mortality. Although not being the primary imaging modality in VHD, cardiac computed tomography (CCT) provides relevant information about its morphology, function, severity grading, and adverse cardiac remodeling assessment. Aortic valve calcification quantification is necessary for grading severity in cases of low-flow/low-gradient aortic stenosis. Moreover, CCT details significant information necessary for adequate percutaneous treatment planning. CCT may help to detail the etiology of VHD as well as to depict other less frequent causes of valvular disease, such as infective endocarditis, valvular neoplasms, or other cardiac pseudomasses.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Radiology Department, Hospital San Juan de Dios, HT Medica, Avenida El Brillante Nº 36, Córdoba 14012, Spain.
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, Peter Munk Cardiac Center, University Health Network (UHN), University of Toronto, 1 PMB-298, 585 University Avenue, Toronto, Ontario M5G2N2, Canada
| | - Brian Ghoshhajra
- Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charles River Plaza East, 165 Cambridge Street, Boston, MA 02114, USA
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Pierard L, Cosyns B. Primary mitral regurgitation and risk models for predicting outcome: time to move to artificial intelligence? Eur Heart J Cardiovasc Imaging 2023; 24:1166-1167. [PMID: 37418576 DOI: 10.1093/ehjci/jead130] [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: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Luc Pierard
- Cardiology, University of Liège, 4020 Liège, Belgium
| | - Bernard Cosyns
- Cardiology-Center of Cardiovascular disease (CHVZ), Universitaire Ziekenhuis Brussel (UZB), 101 Laarbeeklaan, 1090 Brussels, Belgium
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Bennati L, Vergara C, Giambruno V, Fumagalli I, Corno AF, Quarteroni A, Puppini G, Luciani GB. An Image-Based Computational Fluid Dynamics Study of Mitral Regurgitation in Presence of Prolapse. Cardiovasc Eng Technol 2023; 14:457-475. [PMID: 37069336 PMCID: PMC10412498 DOI: 10.1007/s13239-023-00665-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/12/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE In this work we performed an imaged-based computational study of the systolic fluid dynamics in presence of mitral valve regurgitation (MVR). In particular, we compared healthy and different regurgitant scenarios with the aim of quantifying different hemodynamic quantities. METHODS We performed computational fluid dynamic (CFD) simulations in the left ventricle, left atrium and aortic root, with a resistive immersed method, a turbulence model, and with imposed systolic wall motion reconstructed from Cine-MRI images, which allowed us to segment also the mitral valve. For the regurgitant scenarios we considered an increase of the heart rate and a dilation of the left ventricle. RESULTS Our results highlighted that MVR gave rise to regurgitant jets through the mitral orifice impinging against the atrial walls and scratching against the mitral valve leading to high values of wall shear stresses (WSSs) with respect to the healthy case. CONCLUSION CFD with prescribed wall motion and immersed mitral valve revealed to be an effective tool to quantitatively describe hemodynamics in case of MVR and to compare different regurgitant scenarios. Our findings highlighted in particular the presence of transition to turbulence in the atrium and allowed us to quantify some important cardiac indices such as cardiac output and WSS.
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Affiliation(s)
- Lorenzo Bennati
- Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, Italy
| | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
| | - Ivan Fumagalli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Antonio Francesco Corno
- Children’s Heart Institute, McGovern Medical School, UT Health, 6431 Fannin Street, Houston, TX 77030 USA
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- École Polytechnique Fédérale de Lausanne, Rte Cantonale, 1015 Lausanne, Switzerland
| | - Giovanni Puppini
- Department of Radiology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics, and Obstetrics/Gynecology, University of Verona, O. C. M. Piazzale Stefani 1, 37126 Verona, Italy
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Huang A, Chen Y, Huang Y, Ji X, Jiang W. MitraClip as a therapeutic strategy for post-myocardial infarction mitral regurgitation. J Cardiothorac Surg 2023; 18:55. [PMID: 36732840 PMCID: PMC9896774 DOI: 10.1186/s13019-023-02165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Mitral regurgitation is a serious complication of post-myocardial infarction, with increasing mortality. Surgery as the primary treatment carries a high risk. MitraClip is a new therapeutic to treat post-myocardial infarction mitral regurgitation. In this case, a 62-year-old male patient suffered from severe heart failure symptoms after emergency coronary intervention and extracorporeal membrane oxygenation support. Based on cardiac echocardiography, severe mitral regurgitation was monitored in this patient. After MitraClip treatment, the patient's condition was gradually improved and discharged successfully. This case highlights that MitraClip is a safe and effective strategy for post-myocardial infarction mitral regurgitation.
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Affiliation(s)
- Anwu Huang
- grid.507993.10000 0004 1776 6707Department of Cardiology, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, No. 252 Baili East Road, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Ying Chen
- grid.507993.10000 0004 1776 6707Department of Cardiology, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, No. 252 Baili East Road, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Yiwei Huang
- grid.507993.10000 0004 1776 6707Department of Cardiology, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, No. 252 Baili East Road, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Xiaojun Ji
- grid.507993.10000 0004 1776 6707Department of Cardiology, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, No. 252 Baili East Road, Wenzhou, 325000 Zhejiang Province People’s Republic of China
| | - Wenbing Jiang
- grid.507993.10000 0004 1776 6707Department of Cardiology, Wenzhou Central Hospital, The Second Affiliated Hospital of Shanghai University, No. 252 Baili East Road, Wenzhou, 325000 Zhejiang Province People’s Republic of China
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Piątkowski R, Kochanowski J, Budnik M, Grabowski M, Ścisło P, Opolski G. NT-proBNP increase during stress echocardiography predicts significant changes in ischemic mitral regurgitation severity in patients qualified for surgical revascularization. Cardiol J 2022; 29:927-935. [PMID: 32515485 PMCID: PMC9788748 DOI: 10.5603/cj.a2020.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In many patients, significant changes in ischemic mitral regurgitation (IMR) severity during exercise can be observed independent of the degree of IMR at rest. This study aimed to investigate the correlations between N-terminal fragment B-type natriuretic peptide (NT-proBNP) and echocardiography measurements at rest and at peak exercise in patients with moderate IMR who qualified for surgical revascularization. METHODS A total of 100 patients eligible for coronary artery bypass grafting, were included in this prospective study. All patients underwent exercise echocardiography. Additionally, the levels of NT-proBNP were measured at rest and after peak exercise. RESULTS A positive correlation of absolute NT-proBNP levels with effective regurgitant orifice area (EROA) were observed and with tricuspid regurgitant peak gradient (TRPG) at peak exercise. Absolute ΔNT-proBNP during exercise and the tenting area at rest were independent predictors of severe IMR at peak exercise. The level of absolute ΔNT-proBNP during exercise and coaptation height at rest were the most important predictors of significant increases in TRPG. The best cutoff value for ΔNT-proBNP as a predictor for increases in EROA at peak exercise was 68.9 pg/mL and to predict an increase in TRPG ≥ 50 mmHg at peak exercise was 68 pg/mL. CONCLUSIONS The level of ΔNT-proBNP during exercise was the most important parameter in predicting significant changes in IMR severity and pulmonary pressure. Based on the present data, it can be speculated that integration of the assessment of NT-proBNP at rest and at exercise might improve patient selection for valve surgery.
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7
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Transcatheter edge-to-edge repair in patients with mitral regurgitation and cardiogenic shock: a new therapeutic target. Curr Opin Crit Care 2022; 28:426-433. [PMID: 35856980 DOI: 10.1097/mcc.0000000000000952] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Cardiogenic shock with significant mitral regurgitation portends a poor prognosis with limited therapeutic options. Herein, we review the available evidence regarding the patient characteristics, management, impact of transcatheter edge-to-edge repair (TEER) on hemodynamics, and clinical outcomes of patients with cardiogenic shock and mitral regurgitation. RECENT FINDINGS Several observational studies and systematic reviews have demonstrated the feasibility and safety of TEER in cardiogenic shock complicated by degenerative or functional mitral regurgitation. Surgical interventions for mitral regurgitation remain limited owing to the risk profile of patients in cardiogenic shock. TEER has been studied in both degenerative and functional mitral regurgitation and remains feasible in the critically ill population. Moreover, TEER is associated with reduction in mitral regurgitation and improvement in-hospital and long-term mortality. SUMMARY TEER remains a promising therapeutic option in cardiogenic shock complicated by significant mitral regurgitation, but additional research is required to identify patient and procedural characteristics, hemodynamic parameters, and the optimal time for intervention. Moreover, future randomized controlled trials are in progress to evaluate the potential benefit of TEER against medical management in cardiogenic shock and mitral regurgitation.
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8
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Layoun H, Mentias A, Akintoye E, Matta M, Kanaan C, Daou R, Ramchand J, Burns D, Gillinov AM, Bhattacharya S, Puri R, Collier P, Griffin B, Kapadia S, Harb SC. Clinical, functional and prognostic implications of severe atrial dilation in secondary mitral regurgitation. Open Heart 2022; 9:openhrt-2022-001996. [PMID: 35383126 PMCID: PMC8984044 DOI: 10.1136/openhrt-2022-001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Atrial dilation is known to be a poor prognostic indicator. However, its clinical, functional and prognostic implications have not been thoroughly explored in secondary mitral regurgitation (SMR). We sought to describe the implications of severe atrial dilation (SAD) in SMR. Methods We included all adult patients with severe SMR due to left ventricle dysfunction (with no organic mitral valve disease) who underwent transthoracic echocardiography between January 2012 and March 2021 at our institution. The concomitant presence of severe left atrial (LA) dilation (>48 mL/m2) defined SADMR (SAD in SMR), and these patients were compared with those without SAD. Results A total of 2011 patients were included (mean age 70% and 41% females), with 71% having SADMR. MR severity and ejection fraction were similar between both groups. Patients with SADMR were older, less females and had more diabetes, but similar rates of atrial fibrillation. Mechanistically, they had lower A wave velocity (0.61 vs 0.72 cm/sec, p<0.001) and more impaired LA reservoir strain (9.7% vs 15.5%, p<0.001). Geometrically, SADMR had shallower leaflets’ angulations, lower tenting height, larger annuli and smaller leaflet length/annular diameter ratios (all p<0.001). They underwent fewer MV interventions, although these were associated with better outcomes (log-rank p<0.001). Over the study period, SAD was an independent predictor of mortality (HR 1.26, p=0.04). Conclusion SADMR is associated with specific mechanistic and functional alterations and confers a worse prognosis.
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Affiliation(s)
- Habib Layoun
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanuel Akintoye
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Milad Matta
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chris Kanaan
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Remy Daou
- Family Medicine, Hotel-Dieu De France, Achrafieh, Lebanon
| | - Jay Ramchand
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Burns
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick Collier
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C Harb
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Malagoli A, Rossi L, Zanni A, Sticozzi C, Piepoli MF, Benfari G. Quantified mitral regurgitation and left atrial function in heart failure with reduced ejection fraction: interplay and outcome implications. Eur J Heart Fail 2022; 24:694-702. [PMID: 35014120 DOI: 10.1002/ejhf.2429] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/25/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS The clinical and prognostic importance of functional mitral regurgitation (FMR) in heart failure patients with reduced ejection fraction (HFrEF) has been highly debated. This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with left atrial (LA) function in a prospective cohort of consecutive HFrEF outpatients. METHODS AND RESULTS Overall, 286 consecutive outpatients with chronic HFrEF were prospectively enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography. The primary endpoint was a composite of congestive heart failure hospitalization or CV death. During a mean follow-up of 4.1 ± 1.5 years, the primary endpoint occurred in 99 patients (35%). The spline modelling of the risk by FMR severity showed an excess event risk starting at about the EROA value of 0.1 cm2 . There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of CV events (hazard ratio [HR] EROA per 0.10 cm2 increase: 1.42, 95% confidence interval [CI] 1.19-1.68; p < 0.0001). EROA ≥0.30 cm2 was associated with CV events regardless of LA function (HR 2.34, 95% CI 1.29-4.19; p = 0.005). Less severe FMR (EROA ≥0.10 cm2 ) was associated with a dismal outcome only in patients with reduced LA function (PALS <14%) (5-year CV event rate 51 ± 4%); conversely, the risk of events was relative reduced when preserved global PALS and FMR coexisted (5-year CV event rate 38 ± 6%). CONCLUSIONS Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. Within a moderate EROA range, LA function mitigates the clinical consequences of mitral regurgitation, providing measurable proof of the interplay between regurgitation and LA compliance.
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Affiliation(s)
- Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Rossi
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Alessia Zanni
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Massimo F Piepoli
- Division of Cardiology, Department of Cardiology, 'Guglielmo da Saliceto' Hospital, Piacenza, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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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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11
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Claeys MJ, Debonnaire P, Bracke V, Bilotta G, Shkarpa N, Vanderheyden M, Coussement P, Vanderheyden J, de Heyning CMV, Cosyns B, Pouleur AC, Lancellotti P, Paelinck BP, Ferdinande B, Dubois C. Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation. Am J Cardiol 2021; 161:70-75. [PMID: 34794621 DOI: 10.1016/j.amjcard.2021.08.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
The present study aims to assess the clinical and hemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with atrial functional mitral regurgitation (A-FMR) compared with ventricular functional mitral regurgitation (V-FMR). Mitral regurgitation (MR) grade, functional status (New York Heart Association class), and major adverse cardiac events (MACE; all-cause mortality or hospitalization for heart failure) were evaluated in 52 patients with A-FMR and in 307 patients with V-FMR. In 56 patients, hemodynamic assessment during exercise echocardiography was performed before and 6 months after intervention. MR reduction after MitraClip implantation was noninferior in A-FMR compared with V-FMR (MR grade ≤2 at 6 months in 94% vs 82%, respectively, p <0.001 for noninferiority) and was associated with improvement of functional status (New York Heart Association class ≤2 at 6 months in 90% vs 80%, respectively, p = 0.2). Hemodynamic assessment revealed that cardiac output at 6 months was higher in A-FMR at rest (5.1 ± 1.5 L/min vs 3.8 ± 1.5 L/min, p = 0.002) and during peak exercise (7.9 ± 2.4 L/min vs 6.1 ± 2.1 L/min, p = 0.02). In addition, the reduction in systolic pulmonary artery pressure at rest was more pronounced in A-FMR: Δ SPAP -13.1 ± 15.1 mm Hg versus -2.2 ± 13.3 mm Hg (p = 0.03). MACE rate at follow-up was significantly lower in A-FMR versus V-FMR, with an adjusted odds ratio of 0.46 (95% confidence interval 0.24 to 0.88), which was caused by a reduction in hospitalization for heart failure. In conclusion, percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. However, the hemodynamic improvement and reduction of MACE were significantly better in A-FMR.
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Affiliation(s)
- Marc J Claeys
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.
| | | | - Veronique Bracke
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Giada Bilotta
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Nikol Shkarpa
- Dept of cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | | | | | | | - Bernard Cosyns
- Dept of cardiology, Brussels University Hospital, Brussels, Belgium
| | | | | | | | - Bert Ferdinande
- Dept of Cardiology, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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Alkhouli M, Eleid MF, Nishimura RA, Rihal CS. The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions. JACC Cardiovasc Interv 2021; 14:2531-2544. [PMID: 34887047 DOI: 10.1016/j.jcin.2021.08.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/02/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022]
Abstract
Recent advances in transcatheter interventions have refueled the interest in utilizing invasive hemodynamics in the catheterization laboratory. The authors review contemporary invasive techniques used to confirm valve disease and guide transcatheter valve interventions. They also discuss the available data and the remaining questions on the role of invasive hemodynamics in current practice and in the future.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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13
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Piatkowski R, Kochanowski J, Budnik M, Peller M, Grabowski M, Opolski G. Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone. J Clin Med 2021; 10:4816. [PMID: 34768340 PMCID: PMC8585062 DOI: 10.3390/jcm10214816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone. METHODS A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery. RESULTS Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm2 provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; p = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; p = 0.742). CONCLUSIONS The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.
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Affiliation(s)
- Radoslaw Piatkowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (J.K.); (M.B.); (M.P.); (M.G.); (G.O.)
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14
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Senthilnathan G, Dhandapani V, Ramraj B, Logaraj M. Clinical presentation and prognosis of non valvular mitral regurgitation-A single institution experience. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Öner A, Alozie A, Dohmen PM. Hybrid approach for percutaneous mitral valve repair (MitraClip®) followed by minimally invasive direct coronary artery bypass (MIDCAB) in a patient with a high risk constellation. J Card Surg 2021; 36:4419-4422. [PMID: 34490951 DOI: 10.1111/jocs.15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We present a 76-year-old poly-morbid male patient suffering from severe ischemic mitral valve regurgitation. A hybrid approach was suggested by the heart team to treat his multifaceted cardiac pathologies. METHODS At first percutaneous mitral valve repair with the mitraclip device was performed to reduce surgical risk. This was then followed by minimally invasive direct coronary artery bypass (MIDCAB). RESULTS At day 20 Post mitraclip intervention the patient suffered gastrointestinal bleeding which needed argon plasma coagulation (APC)-therapy and multiple blood transfusions. Stage II of the hybrid procedure was executed on post-intervention day 34 by minimally invasive direct coronary artery bypass (MIDCAB) to left anterior descending artery (LAD). Seven days later the patient was discharged. Up to two years of follow-up, the patient is in stable condition, without recurrent cardiac symptoms. CONCLUSION Hybrid approach of percutaneous mitral valve repair followed by MIDCAB is an effective minimally invasive treatment for severe ischemic mitral valve regurgitation and coronary artery disease.
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Affiliation(s)
- Alper Öner
- Department of Cardiology, Heart Centre Rostock, University of Rostock, Rostock, Germany
| | - Anthony Alozie
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Rostock, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Rostock, Germany.,Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Belluschi I, Glauber M, Miceli A. Commentary: What do we still have to learn from surgery? JTCVS OPEN 2021; 7:109-110. [PMID: 36003714 PMCID: PMC9390765 DOI: 10.1016/j.xjon.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
| | - Antonio Miceli
- Department of Cardiac Surgery, Sant'Ambrogio Hospital, Milan, Italy
- Address for reprints: Antonio Miceli, MD, Minimally Invasive Cardiac Department, Istituto Clinico Sant'Ambrogio, Via LG Faravelli 16, 20149 Milano, Italy.
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17
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Ahmed OF, Kakamad FH, Almudhaffar SS, Hachim RH, Najar KA, Salih AM, Hussen DA, Mohammed SH, Mustafa MQ, Mohammed KK, Omar DA. Combined operation for coronary artery bypass grafting and mitral valve replacement; risk and outcome. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Haberman D, Estévez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Nombela-Franco L, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Pascual I, Praz F, Sudarsky D, Kerner A, Ninios V, Gennari M, Beeri R, Perl L, Wasserstrum Y, Danenberg H, Poles L, George J, Caneiro-Queija B, Scianna S, Moaraf I, Schiavi D, Scardino C, Corpataux N, Echarte-Morales J, Chrissoheris M, Fernández-Peregrina E, Di Pasquale M, Regueiro A, Vergara-Uzcategui C, Iñiguez-Romo A, Fernández-Vázquez F, Dvir D, Maisano F, Taramasso M, Shuvy M. Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J 2021; 43:641-650. [PMID: 34463727 DOI: 10.1093/eurheartj/ehab496] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Severe mitral regurgitation (MR) following acute myocardial infarction (MI) is associated with high mortality rates and has inconclusive recommendations in clinical guidelines. We aimed to report the international experience of patients with secondary MR following acute MI and compare the outcomes of those treated conservatively, surgically, and percutaneously. METHODS AND RESULTS Retrospective international registry of consecutive patients with at least moderate-to-severe MR following MI treated in 21 centres in North America, Europe, and the Middle East. The registry included patients treated conservatively and those having surgical mitral valve repair or replacement (SMVR) or percutaneous mitral valve repair (PMVR) using edge-to-edge repair. The primary endpoint was in-hospital mortality. A total of 471 patients were included (43% female, age 73 ± 11 years): 205 underwent interventions, of whom 106 were SMVR and 99 PMVR. Patients who underwent mitral valve intervention were in a worse clinical state (Killip class ≥3 in 60% vs. 43%, P < 0.01), but yet had lower in-hospital and 1-year mortality compared with those treated conservatively [11% vs. 27%, P < 0.01 and 16% vs. 35%, P < 0.01; adjusted hazard ratio (HR) 0.28, 95% confidence interval (CI) 0.18-0.46, P < 0.01]. Surgical mitral valve repair or replacement was performed earlier than PMVR [median of 12 days from MI date (interquartile range 5-19) vs. 19 days (10-40), P < 0.01]. The immediate procedural success did not differ between SMVR and PMVR (92% vs. 93%, P = 0.53). However, in-hospital and 1-year mortality rates were significantly higher in SMVR than in PMVR (16% vs. 6%, P = 0.03 and 31% vs. 17%, P = 0.04; adjusted HR 3.75, 95% CI 1.55-9.07, P < 0.01). CONCLUSIONS Early intervention may mitigate the poor prognosis associated with conservative therapy in patients with post-MI MR. Percutaneous mitral valve repair can serve as an alternative for surgery in reducing MR for high-risk patients.
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Affiliation(s)
- Dan Haberman
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rodrigo Estévez-Loureiro
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | - Tomas Benito-Gonzalez
- Department of Cardiology, University Hospital of León, C/ ALTOS DE NAVA, S/N, León 24071, Spain
| | - Paolo Denti
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu, Carrer de Sant Quintí, 89, Barcelona 08041, Spain
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Xavier Freixa
- Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, 170, Barcelona, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain
| | - Pedro Villablanca
- Interventional Cardiology, The Center for Structural Heart Disease, Henry Ford Hospital, 2799 West Grand Blvd., Detroit, MI, USA
| | - Lian Krivoshei
- Department of cardiology, Kantonsspital Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Neil Fam
- Division of Cardiology, St. Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON M5B 1W8, Canada
| | - Konstantinos Spargias
- Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
| | - Andrew Czarnecki
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Hospital Road, ON M4N 3M5, Canada
| | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Av. Roma, Oviedo 33011, Spain
| | - Fabien Praz
- Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Doron Sudarsky
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Dov Hoz 0, Tiberias, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Medical Center, and B. Rappaport Faculty of Medicine, Technion Medical School, Efron St 1, Haifa 35254, Israel
| | - Vlasis Ninios
- Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pilea, Thessaloniki 55535, Greece
| | - Marco Gennari
- IRCCS Centro Cardiologico Monzino, Department of Cardiovascular Surgery, Via Carlo Parea, 4, Milan 20138, Italy.,HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Ronen Beeri
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel
| | - Leor Perl
- Cardiology Department, Rabin Medical Center and The 'Sackler' Faculty of Medicine, Tel Aviv University, Zeev Jabotinsky St 39 Petah Tikva, 49100, Israel
| | - Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center & Sackler School of Medicine, Tel Aviv University, Derech Sheba 2, Ramat Gan, Tel Aviv, Israel
| | - Haim Danenberg
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel
| | - Lion Poles
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob George
- Heart Center, Kaplan Medical Center, 1, Pasternak Street, Rehovot 7661041, Israel. Affiliated to the Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Berenice Caneiro-Queija
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | - Salvatore Scianna
- HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Igal Moaraf
- Kantonsspital Baden, Department of Cardiology, Im Ergel 1, 5404 Baden, Switzerland
| | - Davide Schiavi
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Claudia Scardino
- Department of Cardiology, Joan XXIII University Hospital, C/ Dr. Mallafrè Guasch, 4, Tarragona 43005, Spain
| | - Noé Corpataux
- Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Julio Echarte-Morales
- Department of Cardiology, University Hospital of León, C/ ALTOS DE NAVA, S/N, León 24071, Spain
| | - Michael Chrissoheris
- Department of Transcatheter Heart Valves, HYGEIA Hospital, Erithrou Stavrou 4, Marousi 151 23, Athens, Greece
| | | | - Mattia Di Pasquale
- Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, Brescia 25123, Italy
| | - Ander Regueiro
- Interventional Cardiology Unit, Hospital Clinic, C.de Villarroel, 170, Barcelona, Spain
| | - Carlos Vergara-Uzcategui
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, IdISSC, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain
| | - Andres Iñiguez-Romo
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Estrada de Clara Campoamor, 341, Vigo 36213, Spain
| | | | - Danny Dvir
- Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu'el Bait, POB 3235, Jerusalem 9103102, Israel
| | - Francesco Maisano
- Cardiochirurgia IRCCS Ospedale San Raffaele, Via Olgettina, 60, Milano 20132, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zürich, Witellikerstrasse 36, Zurich 8008, Switzerland
| | - Mony Shuvy
- Heart Institute, Hadassah-Hebrew University Medical Center, Kalman Ya'akov Man St, Jerusalem 9755506, Israel.,Jesselson Integrated Heart Centre, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12, Shmu'el Bait, POB 3235, Jerusalem 9103102, Israel
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Effect of Neprilysin Inhibition for Ischemic Mitral Regurgitation after Myocardial Injury. Int J Mol Sci 2021; 22:ijms22168598. [PMID: 34445301 PMCID: PMC8395283 DOI: 10.3390/ijms22168598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Angiotensin receptor neprilysin inhibitor (ARNI) treatment reduces functional mitral regurgitation (MR) to a greater extent than angiotensin receptor blocker (ARB) treatment alone, but the mechanism is unclear. We evaluated the mechanisms of how ARNI has an effect on functional MR. After inducing functional MR by left circumflex coronary artery occlusion, male Sprague Dawley rats (n = 31) were randomly assigned to receive the ARNI LCZ696, the ARB valsartan, or corn oil only (MR control). Excised mitral leaflets and left ventricle (LV) were analyzed, and valvular endothelial cells were evaluated focusing on molecular changes. LCZ696 significantly attenuated LV dilatation after 6 weeks when compared with the control group (LV end-diastolic volume, 461.3 ± 13.8 µL versus 525.1 ± 23.6 µL; p < 0.05), while valsartan did not (471.2 ± 8.9 µL; p > 0.05 to control). Histopathological analysis of mitral leaflets showed that LCZ696 strongly reduced fibrotic thickness compared to the control group (28.2 ± 2.7 µm vs. 48.8 ± 7.5 µm; p < 0.05). Transforming growth factor-β and downstream phosphorylated extracellular-signal regulated kinase were also significantly lower in the LCZ696 group. Consequently, excessive endothelial-to-mesenchymal transition (EndoMT) was mitigated in the LCZ696 group compared to the control group and leaflet area was higher (11%) in the LCZ696 group than in the valsartan group. Finally, the MR extent was significantly lower in the LCZ696 group and functional improvement was observed. In conclusion, neprilysin inhibitor has positive effects on LV reverse remodeling and also attenuates fibrosis in MV leaflets and restores adaptive growth by directly modulating EndoMT.
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Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis Outside Randomized Trials. J Am Coll Cardiol 2021; 77:111-123. [PMID: 33446305 DOI: 10.1016/j.jacc.2020.10.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent randomized trials including low-risk patients showed positive results for transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR), but patients with non-tricuspid aortic valve (NTAV), severe coronary artery disease (SevCAD), and those requiring concomitant mitral/tricuspid valve (CMTV) or concomitant ascending aorta replacement (CAAR) interventions were excluded. OBJECTIVES This study sought to evaluate the presence and impact of the main clinical variables not evaluated in TAVR versus SAVR trials (NTAV, SevCAD, and CMTV or CAAR intervention) in a large series of consecutive low-risk patients with severe aortic stenosis (SAS) undergoing SAVR. METHODS Single-center study including consecutive patients with SAS and low surgical risk (Society of Thoracic Surgeons score of <4%) undergoing SAVR. Baseline, procedural characteristics, and 30-day outcomes were prospectively collected. RESULTS Of 6,772 patients with SAS who underwent SAVR between 2000 and 2019, 5,310 (78.4%) exhibited a low surgical risk (mean Society of Thoracic Surgeons score: 1.94 ± 0.87%). Of these, 2,165 patients (40.8%) had at least 1 of the following: NTAV (n = 1,468, 27.6%), SevCAD (n = 307, 5.8%), CMTV (n = 306, 5.8%), and CAAR (n = 560, 10.5%). The 30-day mortality and stroke rates for the overall low-risk SAS cohort were 1.9% and 2.4%, respectively. The mortality rate was similar in the SevCAD (2.6%) and CAAR (2.1%) groups versus the rest of the cohort (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 0.85 to 3.75, and OR: 1.64; 95% CI: 0.88 to 3.05, respectively), lower in the NTAV group (0.9%; OR: 0.42; 95% CI: 0.22 to 0.81), and higher in the CMTV group (5.9%; OR: 2.61; 95% CI: 1.51 to 4.5). CONCLUSIONS In a real-world setting, close to one-half of the low-risk patients with SAS undergoing SAVR exhibited at least 1 major criterion not evaluated in TAVR versus SAVR randomized trials. Clinical outcomes were better than or similar to those predicted by surgical scores in all groups but those patients requiring CMTV intervention. These results may help determine the impact of implementing the results of TAVR-SAVR trials in real practice and may inform future trials in specific groups.
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Igata S, Cotter BR, Hang CT, Strachan M, Raisinghani A, Blanchard DG, DeMaria AN. Clinical and Echocardiographic Predictors of Reduced Survival in Patient with Functional Mitral Regurgitation. Am J Cardiol 2021; 150:95-100. [PMID: 34006372 DOI: 10.1016/j.amjcard.2021.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
Functional mitral regurgitation (FMR) is associated with a poor outcome in patients with reduced left ventricular ejection fraction (LVEF). Two recent studies of percutaneous mitral valvular repair therapy reported disparate results, likely due in part to variable risk among FMR patients. The aim of this study is to define echocardiographic factors of prognostic significance in FMR patients, and particularly to compare ischemic and nonischemic FMR. We followed three hundred sixteen consecutive patients (age 60 ± 14 years, men 70%) with FMR and LVEF ≤ 35% between January 2010 and December 2015 (mean follow-up 3.7 years). Patients were categorized into ischemic (39.6%) and nonischemic (60.4%). MR was graded according to the American Society of Echocardiography guidelines. Although echo findings were similar between ischemic and nonischemic patient, the incidence of death, heart transplantation (HT), or LVAD implantation was higher in ischemic than in nonischemic patients (Log rank p = 0.001). In age and gender adjusted multivariate (11 variables) Cox regression analysis, left atrium volume index (LAVI) was associated with death, HT, or LVAD with hazard ratio of 2.1 for patients with FMR (p = 0.003). LAVI greater than 48.7 mL/m2 predicts adverse outcome in both nonischemic and ischemic FMR (AUC 0.62, p < 0.001). Combined ischemic FMR with LAVI ≥ 48.7 mL/m2 had the highest incident rate of all groups. In conclusion, despite similar LV function and MR severity, ischemic FMR patients had higher mortality than nonischemic patients. Of all echocardiographic parameters, an LAVI ≥ 48.7 mL/m2 predicted adverse clinical outcome.
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Ozel R, Ozer PK, Serbest NG, Atıcı A, Onur I, Bugra Z. Prior angina reduces ıschemic mitral regurgitation in patients with ST-Elevation myocardial ınfarction, role of ıschemic preconditioning. Int J Cardiovasc Imaging 2021; 37:2465-2472. [PMID: 33813680 DOI: 10.1007/s10554-021-02229-9] [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: 01/18/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Mitral regurgitation may develop due to left ventricular (LV) remodeling within 3 months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR). Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rd month in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According to presence of prior angina within 72 h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at 1st, 3rd days and 3rd month. IMR was evaluated by proximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1st and 3rd days, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0 .001) in angina (+) group at 3rd month. NTpro-BNP and hs-TnT levels at 1st day and 3rd month were similar, however CK-MB level at 3rd month was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rd month, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72 h prior to STEMI, suggesting a relation with IPC.
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Affiliation(s)
- Ramime Ozel
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey.
| | - Nail Guven Serbest
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Adem Atıcı
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Imran Onur
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Zehra Bugra
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
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23
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Palmiero G, Melillo E, Ferro A, Carlomagno G, Sordelli C, Ascione R, Monda V, Severino S, Ascione L, Caso P. Significant functional mitral regurgitation affects left atrial function in heart failure patients: haemodynamic correlations and prognostic implications. Eur Heart J Cardiovasc Imaging 2020; 20:1012-1019. [PMID: 30863840 DOI: 10.1093/ehjci/jez036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/17/2018] [Accepted: 02/19/2019] [Indexed: 12/22/2022] Open
Abstract
AIMS Functional mitral regurgitation (FMR) is a well-known pathophysiological factor in heart failure (HF) patients, and left atrial function (LAF) is a novel determinant of clinical status and outcome in this setting. However, little is known about the pathophysiological role of FMR on LAF in HFrEF patients. Aim of this study is to explore the possible interplay between the severity of FMR and LAF in heart failure with reduce ejection fraction (HFrEF) patients and their possible consequences. METHODS AND RESULTS We studied 97 consecutive patients with FMR classified in two groups: mild-to-moderate MR ore less (FMR group, n = 38) and moderate-to-severe or more (SFMR group, n = 59). Using the phasic method, left atrial contractile, conduit, reservoir, and total emptying function (TLAEF) were calculated to assess LAF. SFMR group showed significantly lower values of LAF compared to FMR group. LA dysfunction (LA-dys) was defined for TLAEF values below the median and groups divided in four subgroups based on its presence. Patient with LA-Dys in SFMR group showed a worse clinical status, higher incidence of right ventricular dysfunction (RV-Dys), and pulmonary hypertension (PH), and a significant worse clinical survival compared to all other groups. CONCLUSION In our study, the survival was significantly lower in SFMR/LA-Dys+ group. Furthermore, LA-Dys was strongly related with worse clinical status and higher incidence of PH and RV-Dys. These results suggest that in patients with SFMR and HFrEF, LA-Dys may represent both a marker of more advanced disease and a novel prognostic factor.
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Affiliation(s)
- Giuseppe Palmiero
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Enrico Melillo
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Adele Ferro
- Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy
| | - Guido Carlomagno
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Chiara Sordelli
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Raffaele Ascione
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Vittorio Monda
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Sergio Severino
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Luigi Ascione
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
| | - Pio Caso
- Department of Cardiology, AORN Ospedali dei Colli-Monaldi, Naples, Italy
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24
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Kamoen V, Calle S, De Buyzere M, Timmermans F. Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot? Heart 2020; 106:1719-1725. [PMID: 32732437 DOI: 10.1136/heartjnl-2020-317040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 01/10/2023] Open
Abstract
Recent randomised percutaneous mitral intervention trials in patients with heart failure with secondary mitral regurgitation (SMR) have yielded contrasting results. A 'relative load' or 'proportionality' conceptual framework for SMR has been proposed to partly explain the disparate results. The rationale behind the framework is that SMR depends on the left ventricular dimension and not vice versa. In this review, we provide an in-depth analysis of the proportionality parameters used in this framework and also discuss the regurgitant fraction. We also consider haemodynamic observations in SMR that may affect the interpretation and comparisons among proportionality parameters. The conclusion is that the proportionality concept remains hypothetical and requires prospective validation before envisaging its use at individual patient level for risk stratification or therapeutic decision-making.
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Affiliation(s)
- Victor Kamoen
- Cardiology, University Hospital Ghent, Ghent, Belgium
| | - Simon Calle
- Cardiology, University Hospital Ghent, Ghent, Belgium
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25
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Baldus S, v. Bardeleben RS, Eggebrecht H, Elsässer A, Hausleiter J, Ince H, Kelm M, Kuck KH, Lubos E, Nef H, Raake P, Rillig A, Rudolph V, Schulze PC, Schlitt A, Stellbrink C, Möllmann H. Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren. KARDIOLOGE 2020. [DOI: 10.1007/s12181-020-00409-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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26
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Guazzi M, Generati G, Borlaug B, Alfonzetti E, Sugimoto T, Castelvecchio S, Menicanti L, Bandera F. Redistribution of cardiac output during exercise by functional mitral regurgitation in heart failure: compensatory O2 peripheral uptake to delivery failure. Am J Physiol Heart Circ Physiol 2020; 319:H100-H108. [DOI: 10.1152/ajpheart.00125.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This is an analysis involving 134 heart failure patients with reduced ejection fraction versus 80 controls investigated during functional evaluation with gas exchange and hemodynamic, addressing the severe mitral regurgitation phenotype and testing the hypothesis that the backward cardiac output redistribution to the lung during exercise impairs delivery and overexpresses peripheral extraction. This information is new and has important implications in the management of heart failure.
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Affiliation(s)
- Marco Guazzi
- Cardiology University Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milano, Milano, Italy
| | - Greta Generati
- Cardiology University Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milano, Milano, Italy
| | - Barry Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eleonora Alfonzetti
- Cardiology University Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milano, Milano, Italy
| | - Tadafumi Sugimoto
- Cardiology University Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milano, Milano, Italy
- Department of Clinical Laboratory, Mie University Hospital, Tsu, Japan
| | - Serenella Castelvecchio
- Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bandera
- Cardiology University Department, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, University of Milano, Milano, Italy
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27
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Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options. Nat Rev Cardiol 2020; 17:807-827. [DOI: 10.1038/s41569-020-0395-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
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28
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Mėlinytė K, Mizarienė V, Jurkevičius R. Long-term ischemic mitral regurgitation: which parameters predict decrease or increase in the degree after five years? Minerva Cardioangiol 2020; 68:237-245. [DOI: 10.23736/s0026-4725.20.05021-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Ferket BS, Thourani VH, Voisine P, Hohmann SF, Chang HL, Smith PK, Michler RE, Ailawadi G, Perrault LP, Miller MA, O'Sullivan K, Mick SL, Bagiella E, Acker MA, Moquete E, Hung JW, Overbey JR, Lala A, Iraola M, Gammie JS, Gelijns AC, O'Gara PT, Moskowitz AJ. Cost-effectiveness of coronary artery bypass grafting plus mitral valve repair versus coronary artery bypass grafting alone for moderate ischemic mitral regurgitation. J Thorac Cardiovasc Surg 2020; 159:2230-2240.e15. [PMID: 31375378 PMCID: PMC6960356 DOI: 10.1016/j.jtcvs.2019.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/23/2019] [Accepted: 06/16/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The Cardiothoracic Surgical Trials Network reported that left ventricular reverse remodeling at 2 years did not differ between patients with moderate ischemic mitral regurgitation randomized to coronary artery bypass grafting plus mitral valve repair (n = 150) or coronary artery bypass grafting alone (n = 151). To address health resource use implications, we compared costs and quality-adjusted survival. METHODS We used individual patient data from the Cardiothoracic Surgical Trials Network trial on survival, hospitalizations, quality of life, and US hospitalization costs to estimate cumulative costs and quality-adjusted life years. A microsimulation model was developed to extrapolate to 10 years. Bootstrap and deterministic sensitivity analyses were performed to address uncertainty. RESULTS In-hospital costs were $59,745 for coronary artery bypass grafting plus mitral valve repair versus $51,326 for coronary artery bypass grafting alone (difference $8419; 95% uncertainty interval, 2259-18,757). Two-year costs were $81,263 versus $67,341 (difference 13,922 [2370 to 28,888]), and quality-adjusted life years were 1.35 versus 1.30 (difference 0.05; -0.04 to 0.14), resulting in an incremental cost-effectiveness ratio of $308,343/quality-adjusted life year for coronary artery bypass grafting plus mitral valve repair. At 10 years, its costs remained higher ($107,733 vs $88,583, difference 19,150 [-3866 to 56,826]) and quality-adjusted life years showed no difference (-0.92 to 0.87), with 5.08 versus 5.08. The likelihood that coronary artery bypass grafting plus mitral valve repair would be considered cost-effective at 10 years based on a cost-effectiveness threshold of $100K/quality-adjusted life year did not exceed 37%. Only when this procedure reduces the death rate by a relative 5% will the incremental cost-effectiveness ratio fall below $100K/quality-adjusted life year. CONCLUSIONS The addition of mitral valve repair to coronary artery bypass grafting for patients with moderate ischemic mitral regurgitation is unlikely to be cost-effective. Only if late mortality benefits can be demonstrated will it meet commonly used cost-effectiveness criteria.
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Affiliation(s)
- Bart S Ferket
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vinod H Thourani
- Department of Cardiac Surgery, MedStar Heart & Vascular Institute, Washington, DC; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et Pneumonologie de Québec, Hôpital Laval, Québec, Quebec, Canada
| | | | - Helena L Chang
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter K Smith
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Robert E Michler
- Department of Cardiothoracic and Vascular Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, Va
| | - Louis P Perrault
- Montréal Heart Institute, University of Montréal, Montréal, Quebec, Canada
| | - Marissa A Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md
| | - Karen O'Sullivan
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie L Mick
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael A Acker
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Ellen Moquete
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Judy W Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Mass
| | - Jessica R Overbey
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anuradha Lala
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Margaret Iraola
- Cardiovascular Services, Suburban Hospital of Johns Hopkins Medicine, Bethesda, Md
| | - James S Gammie
- Department of Surgery, Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Patrick T O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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30
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Boudoulas KD, Vallakati A, Pitsis AA, Orsinelli DA, Abraham WT. The Use of MitraClip in Secondary Mitral Regurgitation and Heart Failure. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1606-1612. [PMID: 32461047 DOI: 10.1016/j.carrev.2020.05.015] [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: 03/03/2020] [Revised: 05/02/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
Secondary (also known as functional) mitral regurgitation (MR) has increased substantially over the last several decades due to an increase in the prevalence of dilated cardiomyopathy (ischemic and non-ischemic). Mortality and morbidity in patients with dilated cardiomyopathy is much greater when associated with MR as compared to without MR. MR will result in further left ventricular (LV) volume overload, LV dilation, and pupillary muscle displacement resulting in deterioration of the severity of MR leading to a vicious cycle. Optimization of heart failure medical therapy, and cardiac resynchronization therapy for those that qualify, can improve severity of MR; however, significant MR will persist in certain patients. Transcatheter mitral valve repair to treat significant MR using the MitraClip (Abbott, Menlo Park, California), which grasps and coapts the posterior and anterior mitral valve leaflets, in appropriately selected patients with dilated cardiomyopathy and secondary MR has been shown to improve quality of life and prolong survival.
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Affiliation(s)
| | - Ajay Vallakati
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Antonios A Pitsis
- Department of Cardiothoracic Surgery, St. Luke's Hospital, Thessaloniki, Greece
| | - David A Orsinelli
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
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31
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Farzanegan B, Hosseinpoor Z, Baniasadi S, Seyyedi SR, Rajabi M. An Observational Study of QTc Prolongation in Critically Ill Patients: Identification of Incidence and Predictors. Indian J Crit Care Med 2020; 24:270-275. [PMID: 32565638 PMCID: PMC7297246 DOI: 10.5005/jp-journals-10071-23411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS Despite the importance of abnormal QTc interval values in intensive care unit (ICU) patients, there is a paucity of information on this topic. The current study was designed to identify the incidence and predictors of QTc prolongation in medical (M), surgical (S), and emergency (E) ICUs. MATERIALS AND METHODS A prospective observational study was conducted for 6 months. Patients more than 18 years old who admitted to MICU, SICU, and EICU were included in the study. Electrocardiogram (ECG) was taken on day 1, 3, and 5 of ICU admission. The QTc intervals >460 ms in male and >470 ms in female and increased >60 ms above baseline were considered QTc prolongation. Comparative analysis was done between two groups of patients (normal vs prolonged QTc). Logistic regression models were carried out to determine the predictors of QTc prolongation. RESULTS Incidence of QTc prolongation was 6.5, 9.8, and 15.7% on day 1, 3, and 5 of ICU admission, respectively. On day 1, the history of alcohol addiction and the reason of ICU admission were associated with a prolonged QTc. A significant association was demonstrated between administration of azithromycin and QTc prolongation on day 3. High serum creatinine and hospitalization in EICU were predictors of QTc prolongation on day 5 of ICU admission. CONCLUSION The QTc prolongation is relatively common among patients admitted to ICUs and its incidence increases with increasing length of hospital stay. Predictors of QTc prolongation may be affected by the duration of ICU admission. Physicians should consider these predictors particularly before prescribing QTc-prolonging drugs. HOW TO CITE THIS ARTICLE Farzanegan B, Hosseinpoor Z, Baniasadi S, Seyyedi SR, Rajabi M. An Observational Study of QTc Prolongation in Critically Ill Patients: Identification of Incidence and Predictors. Indian J Crit Care Med 2020;24(4):270-275.
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Affiliation(s)
- Behrooz Farzanegan
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Hosseinpoor
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed R Seyyedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Rajabi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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32
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Meco M, Lio A, Montisci A, Panisi P, Ferrarini M, Miceli A, Glauber M. Meta-analysis of results of subvalvular repair for severe ischemic mitral regurgitation. J Card Surg 2020; 35:886-896. [PMID: 32160341 DOI: 10.1111/jocs.14490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The aim of this meta-analysis was to compare short- and long-term outcomes of patients undergoing mitral annuloplasty (MA) with or without papillary muscle surgery (PMS) for the treatment of ischemic mitral regurgitation (IMR). METHODS A systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were performed. RESULTS Nine studies met the inclusion criteria. This meta-analysis identified 478 patients: 228 patients underwent MA alone and 250 patients underwent concomitant PMS. Early mortality was similar between two groups (odds ratio [OR] 1.14, 95% confidence interval [CI], 0.51-2.53; P = .75). PMS was associated at follow-up with a higher freedom from cardiac-related events (P = .050); moreover, although both surgical techniques had a positive impact on ventricular remodeling, the PMS group showed a significant higher reduction of left ventricle end-diastolic diameter (OR, 4.89, 95% CI, 2.77-7.01; P < .001) and left ventricle end-systolic diameter values (OR, 4.11, 95% CI, 1.98-6.24; P < .001). Finally, PMS compared with MA alone was associated with a significant reduction of recurrent mitral regurgitation at follow-up (OR, 3.25, 95% CI, 1.60-6.59; P = .001). CONCLUSIONS This meta-analysis demonstrated superiority in terms of ventricular remodeling of a combined approach encompassing PMS and MA over MA alone in IMR. Moreover, the association of subvalvular surgery with restrictive MA decreases the incidence of mitral regurgitation recurrence and cardiac-related events at follow-up.
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Affiliation(s)
- Massimo Meco
- Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Antonio Lio
- Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Rome, Italy.,Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Andrea Montisci
- Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.,University of Milan, Milan, Italy
| | - Paolo Panisi
- Cardiac Centre, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Matteo Ferrarini
- Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Antonio Miceli
- Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Mattia Glauber
- Department of Cardiac Surgery and Transplantation, S. Camillo Hospital, Rome, Italy.,Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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33
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Ji Q, Qi XM, Shen JQ, Wang YL, Yang Y, Ding WJ, Xia LM, Wang CS. Patients over 70 years of age with moderate ischemic mitral regurgitation undergoing surgical revascularization plus mitral valve repair: insights from a single-center study of propensity-matched data. Cardiovasc Diagn Ther 2020; 9:568-577. [PMID: 32038946 DOI: 10.21037/cdt.2019.10.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Elderly patients, compared with the young, have a higher burden of surgical risk factors with reduced functional capacity and increased comorbidities conditions, and may have worse clinical outcomes. So far, few reports have focused on clinical outcomes of patients over 70 years of age with moderate chronic ischemic mitral regurgitation (IMR) undergoing mitral valve repair at the time of coronary artery bypass grafting (CABG). This single-center study of propensity-matched data attempts to answer a question: compared with patients with age of 70 or less, whether patients over 70 years of age with moderate IMR undergoing CABG plus mitral valve repair receive poor outcomes. Methods All eligible patients were included in this study and were entered into either an elderly group (n=142) or a control group (n=182) according to patients' age. In-hospital outcomes (consisting of surgical mortality and major postoperative morbidity) and midterm clinical outcomes (including all-cause mortality and recurrent mitral regurgitation) were compared after propensity score matching (1:1). Results Using propensity-score matching, 103 pairs of patients were successfully established in a 1:1 ratio. No significant differences between the two matched groups were found with regard to surgical mortality (5.8% vs. 3.9%, P=0.754) and major postoperative morbidity. A total of 184 patients (91 in the elderly group and 93 in the control group) received regular follow-up visit with the median duration of 38 months [interquartile range (IQR), 27-56 months]. There were not any significant differences between the two matched groups regarding overall survival and recurrent IMR-free survival (stratified log-rank P=0.185 and stratified log-rank P=0.453, respectively). The elderly group as compared to the control group did not affect midterm mortality via cox proportional hazard regression (propensity score adjusted hazard ratio, 1.143; 95% confidence interval, 0.761-1.943; P=0.285). Conclusions Patients over 70 years of age with moderate chronic IMR undergoing combined CABG and mitral valve repair may receive favorable in-hospital and midterm clinical outcomes.
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Affiliation(s)
- Qiang Ji
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Xiao-Min Qi
- Shanghai Municipal Institute of Cardiovascular Diseases, Shanghai 200032, China
| | - Jin-Qiang Shen
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yu-Lin Wang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ye Yang
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Wen-Jun Ding
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Li-Min Xia
- Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China.,Department of Cardiovascular Surgery of Xiamen Branch of Zhongshan Hospital Fudan University, Xiamen 510530, China
| | - Chun-Sheng Wang
- Shanghai Municipal Institute of Cardiovascular Diseases, Shanghai 200032, China
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Micali LR, Qadrouh MN, Parise O, Parise G, Matteucci F, de Jong M, Tetta C, Moula AI, Johnson DM, Gelsomino S. Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation. J Card Surg 2020; 35:645-653. [PMID: 31951676 PMCID: PMC7078820 DOI: 10.1111/jocs.14407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Aims The main pathophysiological factor of chronic ischemic mitral regurgitation (MR) is the outward displacement of the papillary muscles (PMs) leading to leaflet tethering. For this reason, papillary muscle intervention (PMI) in combination with mitral ring annuloplasty (MRA) has recently been introduced into clinical practice to correct this displacement, and to reduce the recurrence of regurgitation. Methods A meta‐analysis was conducted comparing the outcomes of PMI and MRA performed in combination vs MRA performed alone, in terms of MR recurrence and left ventricular reverse remodeling (LVRR). A meta‐regression was carried out to investigate the impact of the type of PMI procedure on the outcomes. Results MR recurrence in patients undergoing both PMI and MRA was lower than in those who only had MRA (log incidence rate ratio, −0.66; lower‐upper limits, −1.13 to 0.20; I2 = 0.0%; p = .44; Egger's test: intercept 0.35 [−0.78 to 1.51]; p = .42). The group with both PMI and MRA and that with only MRA showed a slightly higher reduction in left ventricular diameters (−5.94%; −8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference was detected between PM relocation/repositioning and papillary muscle approximation in terms of LVRR (p = .33). Conclusions Using PMI and MRA together has a lower MR recurrence than using MRA alone. No significant LVRR was observed between the two groups nor between the PMI techniques employed.
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Affiliation(s)
- Linda R Micali
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Mohammad N Qadrouh
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Orlando Parise
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Gianmarco Parise
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Francesco Matteucci
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Monique de Jong
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Cecilia Tetta
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Amalia I Moula
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Daniel M Johnson
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands
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Fabris E, De Luca A, Vitrella G, Stolfo D, Masè M, Korcova R, Merlo M, Rakar S, Van't Hof AWJ, Kedhi E, Perkan A, Sinagra G. Treatment of Functional Mitral Regurgitation in Heart Failure. Curr Cardiol Rep 2019; 21:139. [PMID: 31734930 DOI: 10.1007/s11886-019-1221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To analyze the current state of the art of functional mitral regurgitation (FMR) treatment. RECENT FINDINGS The first-line treatment of severe FMR consists of guideline medical therapy (GMT) and resynchronization therapy when indicated; the impact of new medical therapies like sacubitril/valsartan needs further assessment. Valvular intervention may be considered in FMR symptomatic patients despite GMT, and can be performed surgically or percutaneously. MitraClip is a safe percutaneous procedure associated with symptoms improvement. Recently, the COAPT trial showed superior outcomes for MitraClip versus GMT contrasting the MITRA-FR trial which showed no benefit of MitraClip compared with GMT. These results should be interpreted as complementary rather than opposite. The COAPT trial provided a "proof of concept" that percutaneous treatment of severe FMR in patients without too advanced left ventricular disease translates into a prognostic benefit. Careful patient selection will play a critical role in defining the clinical niche for successful interventions.
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Affiliation(s)
- Enrico Fabris
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy.
| | - Antonio De Luca
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Giancarlo Vitrella
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Masè
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Renata Korcova
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Serena Rakar
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Arnoud W J Van't Hof
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Andrea Perkan
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, University of Trieste, Via Valdoni 7, 34129, Trieste, Italy
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Pype L, Embrechts L, Cornez B, Van Paesschen C, Sarkozy A, Miljoen H, Heuten H, Saenen J, Van Herck P, de Heyning CMV, Heidbuchel H, Claeys MJ. Long-term effect of atrial fibrillation on the evolution of mitral and tricuspid valve regurgitation. Acta Cardiol 2019; 75:639-647. [PMID: 31403908 DOI: 10.1080/00015385.2019.1649339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: The present study aims to identify the long-term effects of atrial fibrillation (AF) on atrial remodelling and on the progression of mitral/tricuspid valve regurgitation (MR/TR). Methods: The severity of MR/TR was assessed by the colour jet area and by multi-integrative approach at baseline and after a period of 65 ± 10 months in 37 patients with permanent AF, in 80 patients with non-permanent AF (of whom 43 were treated with ablation) and in 53 control patients with sinus rhythm. Results: At baseline, AF patients had larger MR jet areas than control patients. At follow up, progression of MR, expressed as delta MR jet area, was 0.05 ± 1.3 cm2 in the control group, 0.73 ± 2.1 cm2 in the non-permanent AF group and 1.95 ± 3.6 cm2 in the permanent AF group (p = .001). Severe MR at follow up was observed in 0%, 2.5%, 8%, respectively. There was a significant positive correlation between progression of MR and increase of left atrium volume (r = 0.31, p < .001). After adjustment for baseline clinical and echocardiographic parameters, permanent AF remained independently associated with the progression of MR. Although rhythm control was better with AF ablation than with medical treatment only, the MR evolution was similar. Comparable findings, albeit less pronounced, were observed for the association between of AF and TR progression. Conclusions: The presence of longstanding AF is associated with a significant progression of MR/TR mainly due to atrial remodelling. Our data showed a beneficial effect of sustained rhythm control, either medically or by ablation, on MR/TR progression.
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Affiliation(s)
- L. Pype
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - L. Embrechts
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - B. Cornez
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - C. Van Paesschen
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - A. Sarkozy
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - H. Miljoen
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - H. Heuten
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - J. Saenen
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - P. Van Herck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - H. Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - M. J. Claeys
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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Tabata N, Sinning JM, Kaikita K, Tsujita K, Nickenig G, Werner N. Current status and future perspective of structural heart disease intervention. J Cardiol 2019; 74:1-12. [DOI: 10.1016/j.jjcc.2019.02.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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Fagiry MA, Hassan IA, Mahmoud MZ. Two-dimensional echocardiography in the diagnosis of ischemic heart disease. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1594129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Moram A. Fagiry
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Diagnostic Radiologic Technology Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Ikhlas A. Hassan
- Diagnostic Radiologic Technology Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mustafa Z. Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Kim J, Alakbarli J, Palumbo MC, Xie LX, Rong LQ, Tehrani NH, Brouwer LR, Devereux RB, Wong SC, Bergman GW, Khalique OK, Levine RA, Ratcliffe MB, Weinsaft JW. Left ventricular geometry predicts optimal response to percutaneous mitral repair via MitraClip: Integrated assessment by two- and three-dimensional echocardiography. Catheter Cardiovasc Interv 2019; 93:1152-1160. [PMID: 30790417 PMCID: PMC6537596 DOI: 10.1002/ccd.28147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess impact of left ventricular (LV) chamber remodeling on MitraClip (MClp) response. BACKGROUND MitraClip is the sole percutaneous therapy approved for mitral regurgitation (MR) but response varies. LV dilation affects mitral coaptation; determinants of MClp response are uncertain. METHODS LV and mitral geometry were quantified on pre- and post-procedure two-dimensional (2D) transthoracic echocardiography (TTE) and intra-procedural three-dimensional (3D) transesophageal echocardiography (TEE). Optimal MClp response was defined as ≤mild MR at early (1-6 month) follow-up. RESULTS Sixty-seven degenerative MR patients underwent MClp: Whereas MR decreased ≥1 grade in 94%, 39% of patients had optimal response (≤mild MR). Responders had smaller pre-procedural LV end-diastolic volume (94 ± 24 vs. 109 ± 25 mL/m2 , p = 0.02), paralleling smaller annular diameter (3.1 ± 0.4 vs. 3.5 ± 0.5 cm, p = 0.002), and inter-papillary distance (2.2 ± 0.7 vs. 2.5 ± 0.6 cm, p = 0.04). 3D TEE-derived annular area correlated with 2D TTE (r = 0.59, p < 0.001) and was smaller among optimal responders (12.8 ± 2.1 cm2 vs. 16.8 ± 4.4 cm2 , p = 0.001). Both 2D and 3D mitral annular size yielded good diagnostic performance for optimal MClp response (AUC 0.73-0.84, p < 0.01). In multivariate analysis, sub-optimal MClp response was associated with LV end-diastolic diameter (OR 3.10 per-cm [1.26-7.62], p = 0.01) independent of LA size (1.10 per-cm2 [1.02-1.19], p = 0.01); substitution of mitral annular diameter for LV size yielded an independent association with MClp response (4.06 per-cm2 [1.03-15.96], p = 0.045). CONCLUSIONS Among degenerative MR patients undergoing MClp, LV and mitral annular dilation augment risk for residual or recurrent MR, supporting the concept that MClp therapeutic response is linked to sub-valvular remodeling.
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Affiliation(s)
- Jiwon Kim
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Javid Alakbarli
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Lola X. Xie
- Division of Cardiology, Memorial Sloan Kettering Cancer Center (New York, New York)
| | - Lisa Q. Rong
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Nathan H. Tehrani
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | - Lillian R. Brouwer
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Shing Chiu Wong
- Greenberg Cardiology Division, Weill Cornell Medicine (New York, New York)
| | | | - Omar K. Khalique
- Division of Cardiology, Columbia University Medical Center (New York, New York)
| | - Robert A. Levine
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School (Boston, MA)
| | - Mark B. Ratcliffe
- Department of Bioengineering, University of California, San Francisco, Veterans Affairs Medical Center (San Francisco, CA)
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Kang DH, Park SJ, Shin SH, Hong GR, Lee S, Kim MS, Yun SC, Song JM, Park SW, Kim JJ. Angiotensin Receptor Neprilysin Inhibitor for Functional Mitral Regurgitation. Circulation 2019; 139:1354-1365. [DOI: 10.1161/circulationaha.118.037077] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.)
| | - Sung-Ji Park
- Division of Cardiology, Samsung Medical Center, Seoul, Korea (S.-J.P., S.-W.P.)
| | - Sung-Hee Shin
- Division of Cardiology, Inha University Medical Center, Incheon, Korea (S.-H.S.)
| | - Geu-Ru Hong
- Division of Cardiology, Severance Medical Center, Seoul, Korea (G.-R.H.)
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.)
| | - Min-Seok Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.)
| | - Sung-Cheol Yun
- Division of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (S.-C.Y.)
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.)
| | - Seung-Woo Park
- Division of Cardiology, Samsung Medical Center, Seoul, Korea (S.-J.P., S.-W.P.)
| | - Jae-Joong Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K., S.L., M.-S.K., J.-M.S., J.-J.K.)
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Abstract
Degenerative myxomatous disease is common and is associated with aging. Poor prognostic indicators for equine aortic regurgitation specifically include ventricular ectopy, increased pulse pressure, and hyperkinetic pulses. Valvular prolapse is a functional abnormality diagnosed echocardiographically, about which knowledge is limited. A better understanding of its role in valvular regurgitation is needed. Infective endocarditis presents with fever and other systemic signs accompanying valvular regurgitation. The prognosis is poor, warranting aggressive therapy. Other forms of valvular disease occur rarely, but often presenting with severe regurgitation. Management of horses with valvular disease is focused on assessment of severity and regular clinical, echocardiographic, and electrocardiographic monitoring.
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Ferket BS, Ailawadi G, Gelijns AC, Acker MA, Hohmann SF, Chang HL, Bouchard D, Meltzer DO, Michler RE, Moquete EG, Voisine P, Mullen JC, Lala A, Mack MJ, Gillinov AM, Thourani VH, Miller MA, Gammie JS, Parides MK, Bagiella E, Smith RL, Smith PK, Hung JW, Gupta LN, Rose EA, O’Gara PT, Moskowitz AJ, Taddei-Peters WC, Buxton D, Geller NL, Gordon D, Jeffries NO, Lee A, Moy CS, Gombos IK, Ralph J, Weisel RD, Gardner TJ, Ascheim DD, Moquete E, Chang H, Chase M, Foo J, Gupta L, Kirkwood K, Dobrev E, Levitan R, O’Sullivan K, Overbey J, Santos M, Williams D, Williams P, Ye X, Mack M, Adame T, Settele N, Adams J, Ryan W, Grayburn P, Chen FY, Nohria A, Cohn L, Shekar P, Aranki S, Couper G, Davidson M, Bolman RM, Lawrence R, Blackstone EH, Geither C, Berroteran L, Dolney D, Doud K, Fleming S, Palumbo R, Whitman C, Sankovic K, Sweeney DK, Pattakos G, Clarke PA, Argenziano M, Williams M, Goldsmith L, Smith CR, Naka Y, Stewart A, Schwartz A, Bell D, Van Patten D, Sreekanth S, Alexander JH, Milano CA, Glower DD, Mathew JP, Harrison JK, Welsh S, Berry MF, Parsa CJ, Tong BC, Williams JB, Ferguson TB, Kypson AP, Rodriguez E, Harris M, Akers B, O’Neal A, Puskas JD, Guyton R, Baer J, Baio K, Neill AA, Senechal M, Dagenais F, O’Connor K, Dussault G, Ballivian T, Keilani S, Speir AM, Magee P, Ad N, Keyte S, Dang M, Slaughter M, Headlee M, Moody H, Solankhi N, Birks E, Groh MA, Shell LE, Shepard SA, Trichon BH, Nanney T, Hampton LC, Mangusan R, D’Alessandro DA, DeRose JJ, Goldstein DJ, Bello R, Jakobleff W, Garcia M, Taub C, Spevak D, Swayze R, Sookraj N, Perrault LP, Basmadjian AJ, Bouchard D, Carrier M, Cartier R, Pellerin M, Tanguay JF, El-Hamamsy I, Denault A, Lacharité J, Robichaud S, Horvath KA, Corcoran PC, Siegenthaler MP, Murphy M, Iraola M, Greenberg A, Sai-Sudhakar C, Hasan A, McDavid A, Kinn B, Pagé P, Sirois C, Young CA, Beach D, Villanueva R, Woo YJ, Mayer ML, Bowdish M, Starnes VA, Shavalle D, Matthews R, Javadifar S, Romar L, Kron IL, Johnston K, Dent JM, Kern J, Keim J, Burks S, Gahring K, Bull DA, Desvigne-Nickens P, Dixon DO, Haigney M, Holubkov R, Jacobs A, Miller F, Murkin JM, Spertus J, Wechsler AS, Sellke F, McDonald CL, Byington R, Dickert N, Dixon DO, Ikonomidis JS, Williams DO, Yancy CW, Fang JC, Giannetti N, Richenbacher W, Rao V, Furie KL, Miller R, Pinney S, Roberts WC, Walsh MN, Hung J, Zeng X, Kilcullen N, Hung D, Keteyian S, Aldred H, Brawner C, Mathew J, Browndyke J, Toulgoat-Dubois Y. Cost-Effectiveness of Mitral Valve Repair Versus Replacement for Severe Ischemic Mitral Regurgitation. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.117.004466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Bart S. Ferket
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville (G.A.)
| | - Annetine C. Gelijns
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Michael A. Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia (M.A.A.)
| | | | - Helena L. Chang
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Denis Bouchard
- Montréal Heart Institute, University of Montréal, QC, Canada (D.B.)
| | | | - Robert E. Michler
- Department of Cardiovascular and Thoracic Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (R.E.M.)
| | - Ellen G. Moquete
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Pierre Voisine
- Institut Universitaire de Cardiologie de Québec, Hôpital Laval, Canada (P.V.)
| | - John C. Mullen
- Division of Cardiac Surgery, University of Alberta, Edmonton, Canada (J.C.M.)
| | - Anuradha Lala
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, TX (M.J.M., R.L.S.)
| | - A. Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, OH (A.M.G.)
| | - Vinod H. Thourani
- Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA and Department of Cardiac Surgery, Med-Star Heart & Vascular Institute, Washington, DC (V.H.T.)
| | - Marissa A. Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (M.A.M.)
| | - James S. Gammie
- Division of Cardiac Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore (J.S.G.)
| | - Michael K. Parides
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
| | - Robert L. Smith
- Department of Cardiothoracic Surgery, Baylor Research Institute, Baylor Scott & White Health, Plano, TX (M.J.M., R.L.S.)
| | - Peter K. Smith
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC (P.K.S.)
| | - Judy W. Hung
- Division of Cardiology, Massachusetts General Hospital, Boston (J.W.H.)
| | | | - Eric A. Rose
- Department of Cardiac Surgery, Mount Sinai Health System, New York, NY (E.A.R.)
| | - Patrick T. O’Gara
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (P.T.O.)
| | - Alan J. Moskowitz
- International Center for Health Outcomes and Innovation Research, the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY (B.S.F., A.C.G., H.L.C., E.G.M., A.L., M.K.P., E.B., A.J.M.)
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Nonaka DF, Fox AA. Ischemic Mitral Regurgitation: Repair, Replacement or Nothing. Semin Cardiothorac Vasc Anesth 2018; 23:11-19. [PMID: 30099939 DOI: 10.1177/1089253218792921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatment strategy for ischemic mitral regurgitation (MR) continues to evolve with the completion of multicenter trials and the advancement of surgical and percutaneous interventional techniques. This review defines ischemic MR, outlines key clinical trials that assess surgical and interventional approaches, and reports the main elements of recent national guidelines for decision making in treatment of ischemic MR. New findings in percutaneous mitral valve repair and replacement for ischemic MR will also be described. Effective perioperative care of patients with ischemic MR requires clinicians to be well versed in the most up-to-date recommendations and emerging technological developments.
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Sandoval Y, Sorajja P, Harris KM. Contemporary Management of Ischemic Mitral Regurgitation: A Review. Am J Med 2018; 131:887-895. [PMID: 29501456 DOI: 10.1016/j.amjmed.2018.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
Ischemic mitral regurgitation occurs relatively frequently in patients with coronary artery disease and is associated with an increased long-term risk. The pathophysiology of ischemic mitral regurgitation is vexing and poses both diagnostic and therapeutic challenges, leading to the need for a comprehensive, multidisciplinary approach. The management is largely focused on medical therapy, and for those eligible, coronary revascularization or cardiac resynchronization therapy may be considered. In select patients, mitral valve surgery or catheter-based therapy may be undertaken with careful consideration of the underlying pathophysiology, surgical risk, and expected long-term outcomes. The appropriate evaluation of patients with ischemic mitral regurgitation involves a careful multidisciplinary approach that carefully considers symptomatology, the etiology and severity of the mitral regurgitation, and the assessment of comorbidities and operative risk to individualize the care of these patients.
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Affiliation(s)
- Yader Sandoval
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn; Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minn
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn
| | - Kevin M Harris
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
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Wang X, Zhang B, Zhang J, Ying Y, Zhu C, Chen B. Repair or replacement for severe ischemic mitral regurgitation: A meta-analysis. Medicine (Baltimore) 2018; 97:e11546. [PMID: 30075522 PMCID: PMC6081181 DOI: 10.1097/md.0000000000011546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The best surgical option for severe ischemic mitral regurgitation (IMR) is still controversial. The aim of this study was to perform a meta-analysis to compare the clinical outcomes of mitral valve repair (MVP) with replacement (MVR). METHODS A literature search was conducted in PubMed, Embase, and Medline using the terms "ischemic mitral regurgitation" and "repair or annuloplasty or reconstruction" and "replacement" in the title/abstract field. The primary outcomes of interest were perioperative mortality and long-term survival. Secondary outcomes were mitral regurgitation (MR) recurrence and reoperation. RESULTS Of 276 studies, 13 studies met the inclusion and exclusion criteria. A total of 1993 patients were included in these studies, consisting of 1259 (63%) repair cases, and 734 (37%) replacement cases. Perioperative mortality was lower with MVP compared with MVR [OR 0.61; (95% CI, 0.43-0.87; P < .05)]. There was no difference with respect to long-term survival [HR 0.75; (95% CI, 0.52-1.09; P = .14)] and reoperation [OR 0.77; (95% CI, 0.38-1.57; P = .47)]. MVP is associated with a higher recurrence of MR [OR = 4.09; (95% CI, 1.82-9.19; P < .001)]. CONCLUSION MVP is associated with a lower perioperative mortality but a higher recurrence of MR compared with MVR for severe IMR. No differences were found with respect to long-term survival and reoperation.
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Hung J, Gammie JS, Ailawadi G. Ideal therapy for secondary mitral regurgitation: should we look under the annulus? Heart 2018; 104:1731-1732. [DOI: 10.1136/heartjnl-2018-313158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mitral annuloplasty ring flexibility preferentially reduces posterior suture forces. J Biomech 2018; 75:58-66. [PMID: 29747965 DOI: 10.1016/j.jbiomech.2018.04.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022]
Abstract
Annuloplasty ring repair is a common procedure for the correction of mitral valve regurgitation. Commercially available rings vary in dimensions and material properties. Annuloplasty ring suture dehiscence from the native annulus is a catastrophic yet poorly understood phenomenon that has been reported across ring types. Recognizing that sutures typically dehisce from the structurally weaker posterior annulus, our group is conducting a multi-part study in search of ring design parameters that influence forces acting on posterior annular sutures in the beating heart. Herein, we report the effect of ring rigidity on suture forces. Measurements utilized custom force sensors, attached to annuloplasty rings and implanted in normal ovine subjects via standard surgical procedure. Tested rings included the semi-rigid Physio (Edwards Lifesciences) and rigid and flexible prototypes of matching geometry. While no significant differences due to ring stiffness existed for sutures in the anterior region, posterior forces were significantly reduced with use of the flexible ring (rigid: 1.95 ± 0.96 N, semi-rigid: 1.76 ± 1.19 N, flexible: 1.04 ± 0.63 N; p < 0.001). The ratio of anterior to posterior FC scaled positively with increasing flexibility (p < 0.001), and posterior forces took more time to reach their peak load when a flexible ring was used (p < 0.001). This suggests a more rigid ring enables more rapid/complete force equilibration around the suture network, transferring higher anterior forces to the weaker posterior tissue. For mitral annuloplasties requiring ring rigidity, we propose a ring design concept to potentially disrupt this force transfer and improve suture retention.
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Lavall D, Hagendorff A, Schirmer SH, Böhm M, Borger MA, Laufs U. Mitral valve interventions in heart failure. ESC Heart Fail 2018; 5:552-561. [PMID: 29676043 PMCID: PMC6073015 DOI: 10.1002/ehf2.12287] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/10/2018] [Indexed: 12/28/2022] Open
Abstract
Secondary mitral regurgitation (MR) results from left ventricular dilatation and dysfunction. Quantification of secondary MR is challenging because of the underlying myocardial disease. Clinical and echocardiographic evaluation requires a multi‐parametric approach. Severe secondary MR occurs in up to one‐fourth of patients with heart failure with reduced ejection fraction, which is associated with a mortality rate of 40% to 50% in 3 years. Percutaneous edge‐to‐edge mitral valve repair (MitraClip) has emerged as an alternative to surgical valve repair to improve symptoms, functional capacity, heart failure hospitalizations, and cardiac haemodynamics. Further new transcatheter strategies addressing MR are evolving. The Carillion, Cardioband, and Mitralign devices were designed to reduce the annulus dilatation, which is a frequent and important determinant of secondary MR. Several transcatheter mitral valve replacement systems (Tendyne, CardiAQ‐Edwards, Neovasc, Tiara, Intrepid, Caisson, HighLife, MValve System, and NCSI NaviGate Mitral) are emerging because valve replacement might be more durable compared with valve repair. In small studies, these interventional therapies demonstrated feasibility and efficiency to reduce MR and to improve heart failure symptoms. However, neither transcatheter nor surgical mitral valve repair or replacement has been proven to impact on the prognosis of heart failure patients with severe MR, which remains high with a mortality rate of 14–20% at 1 year. To date, the primary indication for treatment of secondary severe MR is the amelioration of symptoms, reinforcing the value of a Heart Team discussion. Randomized studies to investigate the treatment effect and long‐term outcome for any transcatheter or surgical mitral valve intervention compared with optimized medical treatment are urgently needed and underway.
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Affiliation(s)
- Daniel Lavall
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, D-04103, Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, D-04103, Germany
| | - Stephan H Schirmer
- Klinik für Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, D-66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, D-66421, Germany
| | - Michael A Borger
- Herzzentrum Leipzig, Universitätsklinik für Herzchirurgie, Leipzig, D-04289, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, D-04103, Germany
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Inciardi RM, Rossi A, Benfari G, Cicoira M. Fill in the Gaps of Secondary Mitral Regurgitation: a Continuum Challenge From Pathophysiology to Prognosis. Curr Heart Fail Rep 2018; 15:106-115. [DOI: 10.1007/s11897-018-0379-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pingpoh C, Siepe M, Bothe W. Surgical treatment of secondary mitral regurgitation: is repair a reasonable option? J Vis Surg 2018; 3:158. [PMID: 29302434 DOI: 10.21037/jovs.2017.09.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/11/2017] [Indexed: 11/06/2022]
Abstract
Background The optimal approach for treating secondary mitral regurgitation (MR) is debated. Since annuloplasty alone has resulted in 30% or more recurrent MR in the mid-term, recent studies suggest mitral valve replacement. However, subvalvular repair strategies as an adjunct to annuloplasty in order to prevent recurrent MR due to ongoing left ventricle (LV) remodeling are becoming increasingly popular. In this study we present short term results of patients with secondary MR who underwent mitral repair using a novel subvalvular repair approach and address the questions whether mitral repair is a reasonable option in these patients. Methods Ten patients presenting with functional MR underwent ring annuloplasty and a subvalvular approximation of the papillary muscles using a technique where the distance between both papillary muscles was adjusted with a Polytetrafluoroethylene (PTFE) string during the saline test (Ring-Noose-String technique). Results Nine of ten patients had none-mild MR while in one patient mild-moderate MR due to ongoing leaflet tethering was diagnosed at discharge. In this patient, insufficient adjustment of the PTFE string is hypothesized as the primary mechanism for suboptimal repair. There were no complications related to the novel surgical technique. No patient died during the follow up period. Conclusions The Ring-Noose-String technique provides acceptable repair results in the short term. A longer follow-up is needed to proof its long-term efficacy. Subvalvular techniques such as this may allow a durable repair in patients with secondary MR.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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