1
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Barnes C, Sharma H, Gamble J, Dawkins S. Management of secondary mitral regurgitation: from drugs to devices. Heart 2024; 110:1099-1106. [PMID: 37607812 DOI: 10.1136/heartjnl-2022-322001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Severe secondary mitral regurgitation carries a poor prognosis with one in five patients dying within 12 months of diagnosis. Fortunately, there are now a number of safe and effective therapies available to improve outcomes. Here, we summarise the most up-to-date treatments. Optimal guideline-directed medical therapy is the mainstay therapy and has been shown to reduce the severity of mitral regurgitation in 40-45% of patients. Rapid medication titration protocols reduce heart failure hospitalisation and facilitate earlier referral for device therapy. The pursuit of sinus rhythm in patients with atrial fibrillation has been shown to significantly reduce mitral regurgitation severity, as has the use of cardiac resynchronisation devices in patients who meet guideline-directed criteria. Finally, we highlight the key role of mitral valve intervention, particularly transcatheter edge-to-edge repair (TEER) for management of moderate-severe mitral regurgitation in carefully selected patients with poor left ventricular systolic function, with a number needed to treat of 3.1 to reduce heart failure hospitalisation and 5.9 to reduce all-cause death. To slow the rapid accumulation of morbidity and mortality, we advocate a proactive approach with accelerated medical optimisation, followed by management of atrial fibrillation and cardiac resynchronisation therapy if indicated, then, rapid referral to the Heart Team for consideration of mitral valve intervention in patients with ongoing symptoms and at least moderate-severe mitral regurgitation. Mitral TEER has been shown to be 'reasonably cost-effective' (but not cost-saving) in the UK in selected patients, although TEER remains underused with only 6.5 procedures per million population (pmp) compared with Germany (77 pmp), Switzerland (44 pmp) and the USA (32 pmp).
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Affiliation(s)
- Cara Barnes
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harish Sharma
- Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Gamble
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Dawkins
- Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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2
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Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Lee S, Sun BJ, Yoon SJ, Lee SH, Kim HY, Kim HM, Park JH, Hong GR, Jung HO, Kim YJ, Kim KH, Kang DH, Ha JW, Kim H. 2023 Korean Society of Echocardiography position paper for the diagnosis and management of valvular heart disease, part II: mitral and tricuspid valve disease. J Cardiovasc Imaging 2024; 32:10. [PMID: 38951920 PMCID: PMC11218416 DOI: 10.1186/s44348-024-00021-6] [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: 09/05/2023] [Accepted: 11/30/2023] [Indexed: 07/03/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the diagnosis and management of valvular heart diseases with referring to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee sought to reflect national data on the topic of valvular heart diseases published to date through a systematic literature search based on validity and relevance. In the part II of this article, we intend to present recommendations for diagnosis and treatment of mitral valve disease and tricuspid valve disease.
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Affiliation(s)
- Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Hwa Lee
- Department of Cardiology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
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3
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Bartorelli AL, Grancini L, Monizzi G, Gallinoro E, Mastrangelo A, Mallia V, Fabbiocchi F, Andreini D. I prefer the MitraClip in these cases: the 5-year COAPT data. Eur Heart J Suppl 2024; 26:i6-i10. [PMID: 38867865 PMCID: PMC11167972 DOI: 10.1093/eurheartjsupp/suae003] [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] [Indexed: 06/14/2024]
Abstract
The COAPT 5-year data demonstrate that compared with medical treatment transcatheter edge-to-edge repair (TEER) with the MitraClip in symptomatic patients with Grade 3+/Grade 4+ secondary mitral regurgitation (SMR) reduced by nearly half the annualized hospitalization risk (33 vs. 57%), by almost 30% the death rate (57 vs. 67%) and achieved significant and durable SMR reduction in 95% of patients. Control patients who crossed over to TEER at 2 years had better prognosis, but nearly half of them died before reaching crossover eligibility. Death or hospitalization for heart failure (HHF) occurred in 73.6% of TEER patients and 91.5% of controls within 5 years, pointing to a need for further study to address left ventricle (LV) dysfunction, the underlying cause of patient's disease. MTRA-FR targeted SMR using the same device and did not improve the composite endpoint of all-cause mortality or HHF at 12 months. Possible reasons for the discrepancy include enrolment of patients with more severe MR and less-advanced LV disease (dilation/dysfunction), less-procedural complications, and higher success in reducing MR in COAPT compared with MITRA-FR. Thus, the ideal patient for MitraClip treatment would be one with severe MR, but with no too severe LV dilation/dysfunction, which is what differentiates COAPT patients from those in MITRA-FR.
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Affiliation(s)
- Antonio L Bartorelli
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan
- Department of Biomedical and Clinical Sciences, University of Milan, Milan
| | | | | | | | | | | | | | - Daniele Andreini
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan
- Department of Biomedical and Clinical Sciences, University of Milan, Milan
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Pedicino D, Vergallo R. Long-lasting effects of transcatheter repair of secondary mitral regurgitation: the latest lesson from COAPT trial. Eur Heart J 2023:ehad349. [PMID: 37312605 DOI: 10.1093/eurheartj/ehad349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Daniela Pedicino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
| | - Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Genova, Italy
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5
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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TEER Gives Years to Life and Life to Years to Elderly Patients With SMR. JACC Cardiovasc Interv 2022; 15:408-410. [PMID: 35093280 DOI: 10.1016/j.jcin.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
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7
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Impact of tolvaptan on improvement of tricuspid regurgitation and right ventricular dimension in patients with right-sided heart failure. Heart Vessels 2022; 37:1153-1161. [PMID: 35050407 DOI: 10.1007/s00380-021-02014-7] [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: 07/05/2021] [Accepted: 12/17/2021] [Indexed: 11/04/2022]
Abstract
Managing right-sided chronic heart failure (CHF) due to tricuspid regurgitation (TR) remains a clinical challenge. Tolvaptan (TLV), a vasopressin V2 receptor inhibitor, is effective in controlling decompensated HF. However, its effects on right-sided CHF caused by TR are unclear. We sought to clarify the effects of TLV in CHF patients complicated with TR. The cohort consisted of 33 CHF patients with moderate or severe TR and permanent atrial fibrillation, who required hospitalization for HF. We observed 19 patients treated with TLV plus conventional therapies (TLV group) and 14 patients with conventional therapies alone (conventional group). Clinical characteristics, echocardiographic parameters, and laboratory data were investigated. Baseline characteristics were similar between groups. In the TLV group, the severity of TR at admission was 73.7% moderate and 26.3% severe. In the conventional group, these percentages were 85.7% and 14.3%, respectively. During the follow-up, the severity of TR improved in the TLV group (trivial-mild: 52.6%; moderate: 36.8%; severe: 10.5%) (p < 0.01). However, it did not improve in the conventional group (trivial-mild: 21.4%; moderate: 50.0%; severe: 28.6%) (p = 0.08). The diameter of the tricuspid annulus (p < 0.01), basal (p = 0.02), and mid right ventricle (p = 0.04) was reduced at follow-up in the TLV group. Nevertheless, these parameters did not change in the conventional group. Serum creatinine levels were maintained (p = 0.74) in the TLV group, but deteriorated in the conventional group (p = 0.03). TLV reduced right ventricular dimensions and improved TR without deterioration of renal function. Thus, TLV may be a new drug for the treatment of CHF patients with TR.
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9
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Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair. J Am Coll Cardiol 2021; 78:2408-2421. [PMID: 34886961 DOI: 10.1016/j.jacc.2021.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although mitral valve transcatheter edge-to-edge repair (M-TEER) achieves symptomatic benefit for a broad spectrum of patients with relevant secondary mitral regurgitation, conflicting data exist on its prognostic impact. OBJECTIVES Adapted enrollment criteria approaching those used in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) and MITRA-FR (Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation) trials were retrospectively applied to a European real-world registry to evaluate the influence of the respective criteria on outcomes. METHODS A total of 1,022 patients included in the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry and treated with M-TEER (November 2008 to September 2019) were stratified into COAPT-eligible (n = 353 [34.5%]) and COAPT-ineligible (n = 669 [65.5%]) as well as MITRA-FR-eligible (n = 408 [48.3%]) and MITRA-FR-ineligible (n = 437 [51.7%]) groups. RESULTS Although the stratification of patients according to adapted MITRA-FR criteria led to comparable outcomes regarding all-cause mortality (P = 0.19), the application of adapted COAPT enrollment criteria demonstrated lower mortality rates in COAPT-eligible compared with COAPT-ineligible patients (P < 0.001). Multivariable Cox regression analysis identified New York Heart Association functional class IV (hazard ratio [HR]: 2.29; 95% confidence interval [CI]: 1.53-3.42; P < 0.001), logarithmic N-terminal pro-brain natriuretic peptide (HR: 1.47; 95% CI: 1.24-1.75; P < 0.001), and right ventricular-to-pulmonary arterial coupling (HR: 0.10; 95% CI: 0.02-0.57; P = 0.009) as independent predictors of outcome. Yet improvement of functional outcome was demonstrated in a subset of patients irrespective of COAPT eligibility status. CONCLUSIONS In this real-world cohort of patients with secondary mitral regurgitation undergoing M-TEER, the retrospective application of adapted COAPT enrollment criteria successfully identified a specific phenotype demonstrating lower mortality rates. On the contrary, stratification according to adapted MITRA-FR criteria resulted in comparable outcomes.
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10
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Praz F, Vahanian A, Milojevic M, Beyersdorf F. Reply to García-Villarreal et al. Eur J Cardiothorac Surg 2021; 62:6459080. [PMID: 34893810 DOI: 10.1093/ejcts/ezab532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alec Vahanian
- UFR Médecine, Université de Paris, Paris, France.,LVTS INSERM U1148, GH Bichat, Paris, France
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Freiburg, Freiburg, Germany.,Medical Faculty of the Albert-Ludwigs-University, Freiburg, Germany
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11
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Brugger N, Kassar M, Siontis GCM, Widmer S, Okuno T, Winkel MG, Corpataux N, Gräni C, Büllesfeld L, Hunziker L, Pilgrim T, Windecker S, Praz F. Integrative echocardiographic assessment of patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Catheter Cardiovasc Interv 2021; 98:1404-1412. [PMID: 34406713 DOI: 10.1002/ccd.29916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/31/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate whether the integrative echocardiographic criteria used in the cardiovascular outcomes assessment of the mitraclip percutaneous therapy (COAPT) for heart failure patients with functional mitral regurgitation study predict outcomes after edge-to-edge trancatheter mitral valve repair (TMVr) for the treatment of secondary mitral regurgitation (SMR). BACKGROUND Two randomized controlled trials comparing TMVr to medical treatment reported conflicting findings. Differences in patient selection criteria may have contributed to these diverging results. METHODS Patients undergoing TMVr were stratified following the integrative COAPT echocardiographic criteria in noneligible and eligible patients who were further classified into three tiers according to effective regurgitant orifice (EROA) (Tier 1: EROA ≥ 0.3cm2 ; Tier 2: EROA 0.2cm2 and 0.29cm2 ; Tier 3: EROA<0.2cm2 ) combined with several other severity criteria. We assessed between group differences in all-cause mortality, successful SMR reduction, and symptom relief from baseline to 2-year follow-up. RESULTS Between March 2011 and March 2018, 138 patients (mean age 75 years) satisfying the inclusion criteria underwent TMVr for treatment of symptomatic SMR. The mean EROA area was 0.35 ± 0.17 mm2 . Ten patients (7%) died within 30 days, 29 (21%) within 12 months, and 41 (30%) within 2 years. After stratification according to the COAPT echocardiographic criteria that were fulfilled in 72% of the studied population, Tier 2 patients (45%), as well as noneligible patients (38%) had a higher mortality rate compared to those in Tier 1 (19%). CONCLUSIONS SMR patients stratified into tiers according to the COAPT integrative echocardiographic criteria have diverging prognostic and symptomatic benefit after edge-to-edge TMVr.
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Affiliation(s)
- Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Sonja Widmer
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam G Winkel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Noé Corpataux
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Lutz Büllesfeld
- Department of Internal Medicine and Cardiology, GFO Hospitals Bonn, Bonn, Germany
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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12
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 304] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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13
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Al-Mohaissen MA, Chow BJW, Lee T, Chan KL. Left atrial-left ventricular angle, a new measure of left atrial and left ventricular remodeling. Int J Cardiovasc Imaging 2021; 38:435-445. [PMID: 34550508 PMCID: PMC8888516 DOI: 10.1007/s10554-021-02411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
Abstract
We assessed the left atrial-left ventricular (LA-LV) long axis angulation value as a new measure of LA remodeling, and studied its predictors, its effect on two-dimensional LA volume (2D LAVol) estimation, and optimization techniques for 2D LAVol values. Retrospective electrocardiogram-gated coronary computed tomographic angiograms of 164 consecutive patients were reviewed. The LA–LV angle was measured in reconstructed 3-chamber views, and its predictors were determined. The LAVol measured by the area-length method after image optimization along the LV long axis (AL) and the LA long axis (AC–AL), was compared with that measured by the three-dimensional (3D)-volumetric method. LAVol calculation was modified to minimize differences from the 3D values. LA–LV angles ranged from 0° to 63°. In the univariate analysis, decreasing angulation was significantly associated with increasing LV end-diastolic volume (LVEDV), mitral regurgitation grade, LV and LA anteroposterior dimensions, and decreasing LV ejection fraction (LVEF). On multivariate analysis, increasing LVEDV, MR, and LA anteroposterior dimension inversely correlated with angulation; LVEF was positively correlated. The AL and 3D methods significantly differed only for patients with angles ≤ 29.9°. Conversely, LAVol was overestimated for all angules by AC–AL. Modification of AL LAVol using a regression equation, or by substituting the shortest with the longest and average LA lengths in patients with angles ≤ 29.9° and 30–39.9°, respectively neutralized the difference. The LA–LV angle is a new measure of LA and LV remodeling predicted by LV size and function, MR, and LA-anteroposterior dimension. AL formula modifications based on angulation in LV-optimized views better correlate with the 3D method than LA-view modification.
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Affiliation(s)
- Maha A Al-Mohaissen
- Department of Clinical Sciences (Cardiology), College of Medicine, Princess Nourah Bint Abdulrahman University, PO Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Benjamin J W Chow
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Medicine (Cardiology), University of Ottawa, Ottawa, ON, Canada
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Kwan-Leung Chan
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Medicine (Cardiology), University of Ottawa, Ottawa, ON, Canada
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14
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2175] [Impact Index Per Article: 725.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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15
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Masuzawa A, Takagi T, Arai H, Matsumiya G, Takanashi S, Yaku H, Komiya T, Matsui Y, Wakasa S, Kunihara T. A Nationwide Survey of Surgical Treatment for Severe Ischemic Mitral Regurgitation. Ann Thorac Cardiovasc Surg 2021; 28:56-62. [PMID: 34334538 PMCID: PMC8915939 DOI: 10.5761/atcs.oa.21-00048] [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] [Indexed: 11/16/2022] Open
Abstract
Objective: Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of specific subvalvular repair in severe IMR have not been elucidated. This is the first nationwide survey regarding surgeons’ attitudes toward IMR in Japan. Methods: A questionnaire was sent to 543 institutions. From 2015 to 2019, numbers of elective first-time mitral valve replacement (MVR) with/without complete chordal preservation (CCP)/papillary muscle approximation (PMA) and mitral valvuloplasty (MVP) with/without papillary muscle relocation (PMR)/PMA in patients with severe IMR were collected. Concomitant procedures for coronary artery, tricuspid valve, and arrhythmia could be included but left ventricular reconstruction was excluded. Results: Completed questionnaires were received from 286 institutions (52.7%). The majority (90%) had less than 20 cases within 5 years. The number of MVP (1413, 61.5%) surpassed MVR (886, 38.5%). CCP was performed in half of MVR (50.0%), while PMA was included in only 1.9% of MVR. PMA and PMR were also performed infrequently, in only 7.7% and 10.9% of MVP, respectively. Conclusion: Japanese surgeons aggressively perform MVP for severe IMR. Subvalvular repair was also aggressively performed in addition to MVR, but not to MVP. A multicenter registry study is in progress.
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Affiliation(s)
- Akihiro Masuzawa
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomomitsu Takagi
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiothoracic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshiro Matsui
- Hanaoka Seishu Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
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16
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Binder RK, Dweck M, Prendergast B. The year in cardiology: valvular heart disease. Eur Heart J 2021; 41:912-920. [PMID: 31901941 DOI: 10.1093/eurheartj/ehz948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/23/2019] [Accepted: 12/24/2019] [Indexed: 01/01/2023] Open
Abstract
Abstract
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Affiliation(s)
- Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels, Wels, Austria
| | - Marc Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic, London, UK
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17
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Corpataux N, Brugger N, Hunziker L, Reineke D, Windecker S, Vahanian A, Praz F. The role of transcatheter mitral valve leaflet approximation for the treatment of secondary mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2021; 18:261-272. [PMID: 33682563 DOI: 10.1080/17434440.2021.1899804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Secondary mitral regurgitation (SMR) is one of the most common valvulopathies and is associated with poor prognosis. Over the past years, medical management and mitral valve repair options have rapidly evolved offering new opportunities for a wide range of patients.Areas covered: We provide an up-to-date review of the value of medical and transcatheter mitral valve leaflet approximation for SMR integrating the results of most recent trials and putting their findings into clinical perspective.Expert opinion: Treatment of SMR requires a multidisciplinary approach with a long-term perspective. After optimization of medical treatment, transcatheter mitral valve repair should be considered in patients with persisting symptomatic severe SMR to improve symptoms and prognosis.
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Affiliation(s)
- Noé Corpataux
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Coats AJS, Anker SD, Baumbach A, Alfieri O, von Bardeleben RS, Bauersachs J, Bax JJ, Boveda S, Čelutkienė J, Cleland JG, Dagres N, Deneke T, Farmakis D, Filippatos G, Hausleiter J, Hindricks G, Jankowska EA, Lainscak M, Leclercq C, Lund LH, McDonagh T, Mehra MR, Metra M, Mewton N, Mueller C, Mullens W, Muneretto C, Obadia JF, Ponikowski P, Praz F, Rudolph V, Ruschitzka F, Vahanian A, Windecker S, Zamorano JL, Edvardsen T, Heidbuchel H, Seferovic PM, Prendergast B. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J 2021; 42:1254-1269. [PMID: 33734354 PMCID: PMC8014526 DOI: 10.1093/eurheartj/ehab086] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/01/2021] [Accepted: 02/21/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary (or functional) mitral regurgitation (SMR) occurs frequently in chronic heart failure (HF) with reduced left ventricular (LV) ejection fraction, resulting from LV remodelling that prevents coaptation of the valve leaflets. Secondary mitral regurgitation contributes to progression of the symptoms and signs of HF and confers worse prognosis. The management of HF patients with SMR is complex and requires timely referral to a multidisciplinary Heart Team. Optimization of pharmacological and device therapy according to guideline recommendations is crucial. Further management requires careful clinical and imaging assessment, addressing the anatomical and functional features of the mitral valve and left ventricle, overall HF status, and relevant comorbidities. Evidence concerning surgical correction of SMR is sparse and it is doubtful whether this approach improves prognosis. Transcatheter repair has emerged as a promising alternative, but the conflicting results of current randomized trials require careful interpretation. This collaborative position statement, developed by four key associations of the European Society of Cardiology-the Heart Failure Association (HFA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association of Cardiovascular Imaging (EACVI), and European Heart Rhythm Association (EHRA)-presents an updated practical approach to the evaluation and management of patients with HF and SMR based upon a Heart Team approach.
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Affiliation(s)
| | - Stefan D Anker
- Department of Cardiology (CVK), Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Germany.,Charité Universitätsmedizin Berlin, Germany
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, and Yale University School of Medicine, New Haven, USA
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Serge Boveda
- Department of Cardiology, Clinique Pasteur, 31076 Toulouse, France
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,State Research Institute Centre For Innovative Medicine, Vilnius, Lithuania
| | - John G Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology, Germany
| | | | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University Munich, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Christoph Leclercq
- Université de Rennes I, CICIT 804, Rennes, CHU Pontchaillou, France, Rennes
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | - Mandeep R Mehra
- Brigham Women's Hospital Heart and Vascular Center and the Center of Advanced Heart Disease, Harvard Medical School, Boston, USA
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Nathan Mewton
- Hôpital Cardio-Vasculaire Louis Pradel, Centre d'Investigation Clinique, Filière Insuffisance Cardiaqu, e, France, Lyon
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University and Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Frank Ruschitzka
- Cardiology Clinic, University Heart Center, University Hospital Zürich, Switzerland
| | | | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain.,University Alcala, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hein Heidbuchel
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | | | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
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19
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Adamo M, Fiorelli F, Melica B, D'Ortona R, Lupi L, Giannini C, Silva G, Fiorina C, Branca L, Chiari E, Chizzola G, Spontoni P, Espada Guerreiro C, Curello S, Petronio AS, Metra M. COAPT-Like Profile Predicts Long-Term Outcomes in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation. JACC Cardiovasc Interv 2020; 14:15-25. [PMID: 33309313 DOI: 10.1016/j.jcin.2020.09.050] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether fulfilling COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) criteria identifies patients with better outcomes after MitraClip treatment for secondary mitral regurgitation (SMR). BACKGROUND To date, COAPT is the only trial showing a prognostic benefit of MitraClip implantation compared with conservative management. METHODS Three hundred four patients with SMR undergoing MitraClip placement in addition to optimal medical therapy at 3 European centers were analyzed. A COAPT-like profile was defined as absence of all the following criteria: severe left ventricular impairment, moderate to severe right ventricular dysfunction, severe tricuspid regurgitation, severe pulmonary hypertension, and hemodynamic instability. Freedom from all-cause death and from a composite endpoint (cardiovascular death and heart failure hospitalization) were evaluated at 2- and 5-year follow-up. RESULTS A COAPT-like profile was observed in 65% of the population. Compared with non-COAPT-like patients, those fulfilling COAPT criteria had greater survival free from all-cause death and from the composite endpoint at both 2 year (75% vs. 55% and 67% vs. 47%; p < 0.001 for both) and 5-year (49% vs. 25% and 40% vs. 19%; p < 0.001 for both) follow-up. Among the non-COAPT-like patients, similar outcomes were observed in those fulfilling 1 or ≥1 criterion. Left ventricular impairment had a late impact on outcomes, while right ventricular impairment, pulmonary hypertension, and hemodynamic instability had early effects. COAPT-like profile was an independent predictor of long-term outcomes, as well as administration of neurohormonal antagonists, European System for Cardiac Operative Risk Evaluation II score, and previous heart failure hospitalization. CONCLUSIONS A COAPT-like profile, including specific echocardiographic and clinical criteria, identifies patients with SMR who have a better prognosis after MitraClip implantation.
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Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Francesca Fiorelli
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Renzo D'Ortona
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Laura Lupi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Gualter Silva
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Claudia Fiorina
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Luca Branca
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Ermanna Chiari
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Paolo Spontoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Salvatore Curello
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy.
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20
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Giallauria F, Di Lorenzo A, Parlato A, Testa C, Bobbio E, Vigorito C, Coats AJS. Individual patient data meta-analysis of the effects of the CARILLON® mitral contour system. ESC Heart Fail 2020; 7:3383-3391. [PMID: 34351074 PMCID: PMC7754746 DOI: 10.1002/ehf2.13125] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Functional mitral regurgitation (MR) (FMR) is common in heart failure with reduced ejection fraction and worsens morbidity and mortality, even when mild. The CARILLON® mitral contour system (Cardiac Dimensions, Kirkland, WA, USA), a mitral annuloplasty device delivered percutaneously to the coronary sinus, is designed to reduce the mitral annular dimension by virtue of the close anatomic relationship between the coronary sinus and the posterior mitral annulus. We performed a comprehensive individual patient data meta-analysis of all studies that used CARILLON® device vs. control that have measured mitral regurgitation severity, left ventricular (LV) remodelling, functional status, and heart failure-related outcomes in heart failure with reduced ejection fraction patients. METHODS AND RESULTS The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched in July 2020. Primary outcomes of interest were measures of MR severity, LV remodelling, New York Heart Association functional class and heart failure-related outcomes [mortality and heart failure hospitalization (HFH) during follow up]. All data were received as individual patient and individual time point data-points. Mean differences and 95% confidence intervals (CIs) were calculated for continuous data using a fixed-effects model. Three studies (REDUCE FMR, TITAN and TITAN II) enrolling 209 participants were identified and included. Pooled analysis showed that, compared with control, CARILLON® device significantly improved both MR volume (mean difference MD -9.20, 95% C.I. -16.11 to -2.29 mL, P = 0.009) and MR grade (MD -1.12, 95% CI -1.36 to -0.88, P < 0.00001) and this was associated with a significant reduction in LA volume, MD -7.54 mL, 95% CI -14.90 to - 0.18, P = 0.04. Significant LV reverse remodelling was also seen in terms of EDV (MD -16.53, 95% CI -28.61 to -44.4 mL, P = 0.007), and a trend in ESV (MD -8.68, 95% CI -18.69 to -1.34 mL, P = 0.09) but no significant effect on LVEF (MD 0.88, 95% CI -1.52% to 2.38%, P = 0.47), due presumably to the greater residual MR in the control patients falsely elevating the LVEF. In addition, the CARILLON® device significantly improved New York Heart Association functional Class (MD -0.22, 95% CI -0.24 to -0.16, P < 0.00001), associated with a lower rate of HFH compared with controls (45.3% vs. 64%, respectively, P = 0.04). As a sensitivity analysis we also restricted the analyses to those patients with Class 3+/4+ MR at baseline. In this cohort, the echocardiographic results were similar, and the reduction in HFH rates was even more marked (43.9% vs. 82.9%, respectively, P = 0.04). CONCLUSIONS This comprehensive meta-analysis of individual patient data has shown that CARILLON® device provides statistically significant and clinically meaningful benefits on MR severity, LA and LV volumes, and remodelling and rates of subsequent heart failure hospitalization.
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Affiliation(s)
- Francesco Giallauria
- Department of Translational Medicine‘Federico II’ University of NaplesNaplesItaly
- Faculty of Science and TechnologyUniversity of New EnglandArmidaleNSWAustralia
| | - Anna Di Lorenzo
- Department of Translational Medicine‘Federico II’ University of NaplesNaplesItaly
| | - Alessandro Parlato
- Department of Translational Medicine‘Federico II’ University of NaplesNaplesItaly
| | - Crescenzo Testa
- Department of Translational Medicine‘Federico II’ University of NaplesNaplesItaly
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital; Department of Molecular and Clinical MedicineInstitute of Medicine at Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Carlo Vigorito
- Department of Translational Medicine‘Federico II’ University of NaplesNaplesItaly
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21
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Lipiecki J, Fahrat H, Monzy S, Caillot N, Siminiak T, Johnson T, Vogt S, Stark MA, Goldberg SL. Long-term prognosis of patients treated by coronary sinus-based percutaneous annuloplasty: single centre experience. ESC Heart Fail 2020; 7:3329-3335. [PMID: 33047896 PMCID: PMC7755003 DOI: 10.1002/ehf2.12955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to report long-term mortality, echocardiographic, and clinical outcomes of patients receiving treatment for functional mitral regurgitation (FMR) with the Carillon device. METHODS AND RESULTS This was a single centre analysis of prospectively collected data from patients treated with the Carillon Mitral Contour System for symptomatic congestive heart failure despite guideline-directed medical therapy, who were included from a single centre from the TITAN II study. All patients presented with New York Heart Association (NYHA) class 2 or greater symptoms, grade 2+ to 4+ FMR, left ventricular enlargement, and reduced ejection fraction. Surviving patients were evaluated for long-term follow-up post-procedure, averaging 6.9 years. Fifteen (15) patients (mean age 72 years, 60% male, 100% NYHA class III or IV, 50% MR grade 3+ or 4+) were treated with the Carillon device. The Kaplan-Meier mortality rate was 40% at 6 years of follow-up. Long-term survival through 6 years was associated with echocardiographic improvement in mitral regurgitation (change in effective regurgitant orifice area in survivors versus non-survivors from baseline to 1 year follow-up, -9.0 ± 5.6 vs. -1.7 ± 1.5, P = 0.02) and clinical status at 12 months (difference in NYHA at 1 year follow-up between survivors versus non-survivors, P = 0. 05) which was sustained throughout follow-up. All patients at 6 year follow-up had ≤2+ MR, with 6 of 7 having 0-1+ MR. Left ventricular end-diastolic volume was reduced from 154.0 ± 65.7 mL at baseline to 104.5 ± 59.2 mL at 6 year follow-up, P = 0.03 in survivors with both measurements. CONCLUSIONS Among patients with congestive heart failure treated with the Carillon device, long-term survival is associated with favourable 1 year and sustained improvements in mitral regurgitation, left ventricular volume, ejection fraction, and clinical status.
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Affiliation(s)
- Janusz Lipiecki
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Hicham Fahrat
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Séverine Monzy
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Nicolat Caillot
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical CenterPoznanPoland
| | | | | | | | - Steven L. Goldberg
- Cardiac DimensionsKirklandWAUSA
- Tyler Heart Institute at Community Hospital of the Monterey PeninsulaMontereyCAUSA
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22
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Armoiry X, Obadia JF, Auguste P, Connock M. Conflicting findings between the Mitra-Fr and the Coapt trials: Implications regarding the cost-effectiveness of percutaneous repair for heart failure patients with severe secondary mitral regurgitation. PLoS One 2020; 15:e0241361. [PMID: 33166308 PMCID: PMC7652317 DOI: 10.1371/journal.pone.0241361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Two randomized controlled trials (RCTs), Mitra-Fr and Coapt, evaluating the benefit of percutaneous repair (PR) for heart failure (HF) patients with severe mitral regurgitation, have led to conflicting results. We aimed to evaluate the impact of these trial results on the cost-effectiveness of PR using effectiveness inputs from the two RCTs. METHODS We developed a time varying Markov type model with three mutually exclusive health states: alive without HF hospitalisation, alive with HF hospitalisation, and dead. Clinically plausible extrapolations beyond observed data were obtained by developing parametric modelling for overall survival and HF hospitalisations using published data from each trial. We adopted the perspective of the French Health System and used a 30-year time horizon. Results were expressed as € / quality-adjusted life year (QALY) gained using utility inputs from literature. FINDINGS Results are presented using treatment efficacy measures from Mitra-F and Coapt trials respectively. With the Mitra-Fr data, after annual discounting, the base case model generated an incremental 0.00387 QALY at a cost of €25,010, yielding an incremental cost effectiveness ratio (ICER) of €6,467,032 / QALY. The model was sensitive to changes made to model inputs. There was no potential of PR being cost-effective. With the Coapt data, the model generated 1.19 QALY gain at a cost of €26,130 yielding an ICER of €21,918 / QALY and at a threshold of >€50,000/QALY PR had a probability of 1 of being cost-effective. IMPLICATIONS Cost effectiveness results were conflicting; reconciling differences between trials is a priority and could promote optimal cost effectiveness analyses and resource allocation.
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, Pharmacy Department, University of Lyon, Lyon, France
- * E-mail:
| | - Jean-François Obadia
- Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Peter Auguste
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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23
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Iung B. NYHA Functional Class in Secondary Mitral Regurgitation: An Old Classification to Evaluate an Innovative Technique. JACC Cardiovasc Interv 2020; 13:2329-2330. [PMID: 33092706 DOI: 10.1016/j.jcin.2020.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Paris, France; Cardiology Department, Université de Paris, Paris, France.
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24
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Hagendorff A, Knebel F, Helfen A, Stöbe S, Doenst T, Falk V. Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging 2020; 37:183-196. [PMID: 32851501 PMCID: PMC7878255 DOI: 10.1007/s10554-020-01975-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Abstract
The contradictory findings of recent prospective randomized controlled trials assessing the impact of percutaneous edge-to-edge repair in patients with functional or secondary mitral regurgitation have triggered a lively discussion about an “integrated” echocardiographic approach for grading severity of mitral regurgitation. In the MITRA-FR trial, the COAPT trial and the REDUCE-FMR trial echocardiographic assessment of the severity of mitral regurgitation was consistent with principles set forth by the current echocardiographic guidelines and analysed in its best settings by expert international leaders in the field of echocardiography. However, serious inconsistencies appeared in the presented echocardiographic assessments regarding cardiac output and regurgitant fraction. A new term “disproportionate functional mitral regurgitation” was introduced describing a situation where the increase of effective regurgitant orifice area exceeds the enlargement of the left ventricular end-diastolic volumes. Further discussion resulted in the idea of a “new conceptional framework” for distinguishing “proportionate” and “disproportionate” functional mitral regurgitation. The aim of this viewpoint is to dispute conclusions based on the term “disproportionate” mitral regurgitation. A “disproportionate” FMR is highly questionable because disproportionateness of flow in communication vessels cannot exist. In addition, a proposal of echocardiographic assessment based on a conventional comprehensive transthoracic echocardiography is given to avoid obvious hemodynamic contradictions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Leipzig, Germany.
- Department of Cardiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Andreas Helfen
- Department of Cardiology, St. Marien Hospital Lünen, Lünen, Germany
- Co-Speaker of the Working Group "Cardiovascular Ultrasound" of the German Society of Cardiology, Düsseldorf, Germany
| | - Stephan Stöbe
- Department of Cardiology, University of Leipzig, Leipzig, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, University of Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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25
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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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26
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Winkel MG, Praz F, Wenaweser P. Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions. Front Cardiovasc Med 2020; 7:61. [PMID: 32500083 PMCID: PMC7242641 DOI: 10.3389/fcvm.2020.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Valvular heart disease is responsible for a high rate of morbidity and mortality, especially in the elderly population. With the emergence of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has considerably expanded during the past years. Interventional treatment of the mitral and tricuspid valve requires an individualized and versatile approach owing to the different etiologies of valvular dysfunction and the complex anatomy of the atrioventricular valves. This article aims to review recent developments, summarize the evidence, indications and limitations of the available systems, and provide a glimpse into the future of transcatheter interventions for the treatment of mitral and tricuspid valve disease.
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Affiliation(s)
- Mirjam Gauri Winkel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Heart Clinic Hirslanden Zurich, Zurich, Switzerland
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27
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Liang B, Zhao YX, Zhang XX, Liao HL, Gu N. Reappraisal on pharmacological and mechanical treatments of heart failure. Cardiovasc Diabetol 2020; 19:55. [PMID: 32375806 PMCID: PMC7202267 DOI: 10.1186/s12933-020-01024-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a highly frequent disorder with considerable morbidity, hospitalization, and mortality; thus, it invariably places pressure on clinical and public health systems in the modern world. There have been notable advances in the definition, diagnosis, and treatment of HF, and newly developed agents and devices have been widely adopted in clinical practice. Here, this review first summarizes the current emerging therapeutic agents, including pharmacotherapy, device-based therapy, and the treatment of some common comorbidities, to improve the prognosis of HF patients. Then, we discuss and point out the commonalities and areas for improvement in current clinical studies of HF. Finally, we highlight the gaps in HF research. We are looking forward to a bright future with reduced morbidity and mortality from HF.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu-Xiu Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
| | | | - Hui-Ling Liao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
- College of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
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28
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Chehab O, Roberts-Thomson R, Ng Yin Ling C, Marber M, Prendergast BD, Rajani R, Redwood SR. Secondary mitral regurgitation: pathophysiology, proportionality and prognosis. Heart 2020; 106:716-723. [DOI: 10.1136/heartjnl-2019-316238] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 01/17/2023] Open
Abstract
Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.
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29
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Maggiore P, Anastasius M, Huang AL, Blanke P, Leipsic J. Transcatheter Mitral Valve Repair and Replacement: Current Evidence for Intervention and the Role of CT in Preprocedural Planning-A Review for Radiologists and Cardiologists Alike. Radiol Cardiothorac Imaging 2020; 2:e190106. [PMID: 33778537 DOI: 10.1148/ryct.2020190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 01/21/2023]
Abstract
The mitral valve is a complex structure with a three-dimensional saddle shape annulus. Mitral regurgitation occurs from leaflet coaptation failure that is either primary (a problem with the leaflets) or secondary (chamber dilatation in the setting of cardiomyopathy). There has been an increase in focus on transcatheter mitral valve interventions, for both mitral repair and replacement. These technologies have rapidly developed to provide treatment for a substantial number of patients with severe symptomatic mitral regurgitation who are at too high of a risk to undergo open heart surgery. CT assessment of the mitral valve has developed with equal rapidity, with regard to preprocedural planning for transcatheter therapies. This review will provide an overview of mitral valve anatomy, an update on the current transcatheter repair and replacement therapies, as well as a focused overview of the role of multislice CT in mitral assessment prior to intervention. © RSNA, 2020.
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Affiliation(s)
- Paul Maggiore
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Malcolm Anastasius
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Alex L Huang
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
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30
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Adamo M, Metra M. Percutaneous treatment of mitral regurgitation: looking for a final model. Intern Emerg Med 2020; 15:13-15. [PMID: 31938988 DOI: 10.1007/s11739-020-02274-7] [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: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Marianna Adamo
- Cardio-Thoracic Department, Civil Hospitals, Brescia, Italy
| | - Marco Metra
- Cardio-Thoracic Department, Civil Hospitals, Brescia, Italy.
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili, 1, Brescia, Italy.
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31
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Praz F, Windecker S. Two-year outcomes of the MITRA-FR trial: towards an integrated approach in the evaluation of patients with secondary mitral regurgitation. Eur J Heart Fail 2019; 21:1628-1631. [PMID: 31773876 DOI: 10.1002/ejhf.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
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32
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Baumbach A, Dudek D, Baumgartner H, Windecker S, Haude M. Evolving paradigms in valvular heart disease: where should guidelines move? EUROINTERVENTION 2019; 15:851-856. [PMID: 31746751 DOI: 10.4244/eij-d-19-00818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The field of valve intervention is rapidly changing. Clinical practice guidelines are based on evidence and practical clinical experience. The randomised trials considered for the guideline recommendations regarding indications for TAVI cover the high-risk and intermediate-risk subgroups of patients. With new evidence for low-risk patients, consideration has to be given to discussing TAVI as the default strategy in the majority of patients. This is a paradigm shift from the established practice. More than ever, the patient will be at the centre of the decision making. The Heart Team is essential for optimal patient pathways, as patient factors, longevity and durability considerations have to inform the discussion. Further developments discussed in this article revolve around evidence on secondary mitral regurgitation and mitral edge-to-edge repair.
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Affiliation(s)
- Andreas Baumbach
- William Harvey Research Institute, Queen Mary University of London, and Barts Heart Centre, London, United Kingdom
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33
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Iung B, Armoiry X, Vahanian A, Boutitie F, Mewton N, Trochu JN, Lefèvre T, Messika-Zeitoun D, Guerin P, Cormier B, Brochet E, Thibault H, Himbert D, Thivolet S, Leurent G, Bonnet G, Donal E, Piriou N, Piot C, Habib G, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Saint Etienne C, Leroux L, Gilard M, Samson G, Rioufol G, Maucort-Boulch D, Obadia JF. Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years. Eur J Heart Fail 2019; 21:1619-1627. [PMID: 31476260 DOI: 10.1002/ejhf.1616] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS The MITRA-FR trial showed that among symptomatic patients with severe secondary mitral regurgitation, percutaneous repair did not reduce the risk of death or hospitalization for heart failure at 12 months compared with guideline-directed medical treatment alone. We report the 24-month outcome from this trial. METHODS AND RESULTS At 37 centres, we randomly assigned 304 symptomatic heart failure patients with severe secondary mitral regurgitation (effective regurgitant orifice area >20 mm2 or regurgitant volume >30 mL), and left ventricular ejection fraction between 15% and 40% to undergo percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical treatment alone (control group, n = 152). The primary efficacy outcome was the composite of all-cause death and unplanned hospitalization for heart failure at 12 months. At 24 months, all-cause death and unplanned hospitalization for heart failure occurred in 63.8% of patients (97/152) in the intervention group and 67.1% (102/152) in the control group [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause mortality occurred in 34.9% of patients (53/152) in the intervention group and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50). Unplanned hospitalization for heart failure occurred in 55.9% of patients (85/152) in the intervention group and 61.8% (94/152) in the control group (HR 0.97, 95% CI 0.72-1.30). CONCLUSIONS In patients with severe secondary mitral regurgitation, percutaneous repair added to medical treatment did not significantly reduce the risk of death or hospitalization for heart failure at 2 years compared with medical treatment alone.
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Affiliation(s)
- Bernard Iung
- Université de Paris and INSERM 1148, Paris, France.,APHP, Hôpital Bichat, DHU FIRE, Paris, France
| | - Xavier Armoiry
- Pharmacy Department and Laboratoire MATEIS, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | - Florent Boutitie
- Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Villeurbanne, France
| | - Nathan Mewton
- Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center & Heart Failure Department, INSERM 1407, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Jean-Noël Trochu
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | - David Messika-Zeitoun
- Université de Paris and INSERM 1148, Paris, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Patrice Guerin
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | - Eric Brochet
- Université de Paris and INSERM 1148, Paris, France
| | - Hélène Thibault
- Hôpital Cardiovasculaire Louis Pradel, Service des Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | - Sophie Thivolet
- Hôpital Cardiovasculaire Louis Pradel, Service des Explorations Fonctionnelles Cardiovasculaires, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | | | | | - Erwan Donal
- CHU Rennes, Hôpital Pontchaillou, Rennes, France
| | - Nicolas Piriou
- CHU Nantes, INSERM, Nantes Université, Clinique Cardiologique et des Maladies Vasculaires, CIC 1413, Institut du Thorax, Nantes, France
| | | | | | | | | | | | - Patrick Ohlmann
- Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | | | | | | | - Géraldine Samson
- Hopital Cardiovasculaire Louis Pradel, Clinical Investigation Center & Heart Failure Department, INSERM 1407, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Gilles Rioufol
- Hopital Cardiovasculaire Louis Pradel, Service d'Hémodynamique et Cardiologie Interventionnelle, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Delphine Maucort-Boulch
- Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Villeurbanne, France
| | - Jean François Obadia
- Hopital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
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34
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Tamburino C, Piazza N, Baumbach A, Windecker S, Maisano F, Prendergast BD. 2019 – A leap year for valvular heart disease. EUROINTERVENTION 2019; 15:821-823. [DOI: 10.4244/eijv15i10a154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Delhomme C, Tence N, Karam N. [Percutaneous treatment of mitral regurgitation]. Ann Cardiol Angeiol (Paris) 2019; 68:468-473. [PMID: 31653330 DOI: 10.1016/j.ancard.2019.09.023] [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: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022]
Abstract
Mitral regurgitation (MR) is currently the most frequent valvular heart disease, and the second most operated valve in Europe. Around 50% of patients presenting severe MR are denied surgery, despite the adverse prognosis associated with the absence of treatment, due to comorbidities and/or advanced age. During the previous years, percutaneous treatment of MR, whether by replacement or, more frequently, by repair, has been developed, providing an alternative for those patients who are deemed at prohibitive, but also, high surgical risk. Percutaneous edge-to-edge repair is currently the most frequently used technique, and is the only one recommended by the European Guidelines for Valvular Heart Disease Management. In the current article, we review the different strategies for MR repair, as well as the indications and level of evidence for their use.
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Affiliation(s)
- C Delhomme
- Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Université Paris Descartes, Paris, France
| | - N Tence
- Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Université Paris Descartes, Paris, France
| | - N Karam
- Département de cardiologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France; Université Paris Descartes, Paris, France; Inserm Unité 970, Équipe 4, Paris, France.
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36
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Lüscher TF. Frontiers of surgical and catheter-based management of valvular heart disease. Eur Heart J 2019; 40:2173-2176. [PMID: 33215679 DOI: 10.1093/eurheartj/ehz480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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37
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Praz F, Windecker S, Kapadia S. PASCAL. JACC Cardiovasc Interv 2019; 12:1379-1381. [DOI: 10.1016/j.jcin.2019.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 11/16/2022]
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