1
|
Izumi Y, Kagiyama N, Maekawara S, Terada M, Higuchi R, Saji M, Takamisawa I, Nanasato M, Isobe M. Transcatheter edge-to-edge mitral valve repair with extended clip arms for ventricular functional mitral regurgitation. J Cardiol 2023; 82:240-247. [PMID: 37116648 DOI: 10.1016/j.jjcc.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The new sizing options of the MitraClip system (Abbott Vascular, Abbott Park, IL, USA) with extended clip arms were recently developed. Its applicability and effectiveness for ventricular functional mitral regurgitation (VFMR) are yet to be investigated. METHODS We retrospectively reviewed consecutive patients with symptomatic VFMR who underwent transcatheter edge-to-edge repair between 2018 and 2022 at the Sakakibara Heart Institute. Pre- and post-procedural mitral valve morphologies were assessed using three-dimensional transesophageal echocardiography. RESULTS In a total of 104 VFMR patients, the posterior mitral leaflet length was 12.8 ± 2.8 mm and 92 % was indicative of the extended arm (≥9 mm). Although baseline VFMR was more severe in the patients treated with the extended arms (n = 35, XT group) than the patients treated with the standard arms (n = 69, NT group), the decrease in VFMR was greater in the XT group (delta three-dimensional vena contracta area - 43 ± 33 mm2 vs. -31 ± 22 mm2, p = 0.030) and residual VFMR was similar between the groups, with a significantly greater reduction in the mitral annulus anterior-posterior diameter (-4.9 ± 2.2 mm vs -3.1 ± 2.1 mm, p < 0.001) and mitral annulus area in the XT group. The use of extended arms was independently associated with shorter procedure time (81 ± 26 min vs 108 ± 41 min) after adjustment for device generation and the number of clips (p = 0.017). CONCLUSIONS Most VFMR patients had enough leaflet lengths for transcatheter edge-to-edge repair using the MitraClip with the extended arms, which was associated with shorter procedure time and a greater decrease in the mitral annular size.
Collapse
Affiliation(s)
- Yuki Izumi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | | | - Mai Terada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| |
Collapse
|
2
|
Onishi H, Izumo M, Naganuma T, Nakamura S, Akashi YJ. Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future. Front Cardiovasc Med 2022; 9:883450. [PMID: 35548414 PMCID: PMC9081364 DOI: 10.3389/fcvm.2022.883450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed.
Collapse
Affiliation(s)
- Hirokazu Onishi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toru Naganuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
3
|
Dabiri Y, Mahadevan VS, Guccione JM, Kassab GS. A Simulation Study of the Effects of Number and Location of MitraClips on Mitral Regurgitation. JACC. ADVANCES 2022; 1:100015. [PMID: 38939090 PMCID: PMC11198285 DOI: 10.1016/j.jacadv.2022.100015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 06/29/2024]
Abstract
Background MitraClip (MC) is a device that is implanted on the mitral valve (MV) percutaneously to treat severe mitral regurgitation (MR). It is common practice to place the MCs at the site of the most significant MR jets identified by echocardiography. Objectives We used computational modeling to examine changes in MR after MC placement. Methods Echocardiographic images from 29 patients with MR were analyzed to reconstruct geometries for finite element simulations and created fluid structure interaction models of the MV with deformable hyperelastic material, the left ventricle as the surrounding geometry, and blood flow. Blood flow was modelled with smoothed particle hydrodynamics. The number of blood particles on the atrial side of MV was used to estimate MR. MC placement was based on the MR jets (jet-based strategy using primary and secondary jets) and simulation models using various MCs locations. Results Computational modelling was able to quantitate reductions in MR after MC placement. Reduction in MR was related to the number of MCs used: 42% reduction with 1 MC, 62% with 2 MCs, and 88% with 3 MCs. Using 2 MCs did not always result in an MR reduction greater than with a single MC. In 31% (9 of 29) of patients, the jet-based strategy did not lead to maximum MR reduction. The majority of patients (89%) who did not have maximal MR reduction with the MC placement using the jet-based strategy, had wide jets, and/or had multiple jets. Conclusions Subject-specific simulation models may be helpful to identify optimal locations for MC placement in patients with MR.
Collapse
|
4
|
Cimino S, Agati L, Filomena D, Maestrini V, Monosilio S, Birtolo LI, Mocci M, Mancone M, Sardella G, Grayburn P, Fedele F. 3D Echo Characterization of Proportionate and Disproportionate Functional Mitral Regurgitation before and after Percutaneous Mitral Valve Repair. J Clin Med 2022; 11:645. [PMID: 35160100 PMCID: PMC8836818 DOI: 10.3390/jcm11030645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of percutaneous mitral valve repair (PMVr) on long-term prognosis in patients with functional mitral regurgitation (FMR) is still unclear. Recently, a new conceptual framework classifying FMR as proportionate (P-MR) and disproportionate (D-MR) was proposed, according to the effective regurgitant orifice area/left ventricular end-diastolic volume (EROA/LVEDV) ratio. The aim was to assess its possible influence on PMVr efficacy. METHODS A total of 56 patients were enrolled. MV annulus, LV volumes and function were assessed. Global longitudinal strain (GLS) was also calculated. Patients were divided into two groups, according to the EROA/LVEDV ratio. Echocardiographic follow-up was performed after 6 months, and adverse events were collected after 12 months. RESULTS D-MR patients (n = 28, 50%) had a significantly more elliptical MV annulus (p = 0.048), lower tenting volume (p = 0.01), higher LV ejection fraction (LVEF: 32 ± 7 vs. 26 ± 5%, p = 0.003), lower LVEDV, LV end-systolic volume (LVESV) and mass (LVEDV/i: 80 ± 20 vs. 126 ± 27 mL, p = 0.001; LVESV/i: 60 ± 20 vs. 94 ± 23 mL, p < 0.001; LV mass: 249 ± 63 vs. 301 ± 69 gr, p = 0.035). GLS was more impaired in P-MR (p = 0.048). After 6 months, P-MR patients showed a higher rate of MR recurrence. After 12 months, the rate of CV death and rehospitalization due to HF was significantly higher in P-MR patients (46% vs. 7%, p < 0.001). P-MR status was strongly associated with CV death/rehospitalization (HR = 3.4, CI 95% = 1.3-8.6, p = 0.009). CONCLUSIONS Patients with P-MR seem to have worse outcomes after PVMr than D-MR patients. Our study confirms the importance of the EROA/LVEDV ratio in defining different subsets of FMR based on the anatomical characteristic of MV and LV.
Collapse
Affiliation(s)
- Sara Cimino
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Michele Mocci
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| | - Paul Grayburn
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX 75246, USA;
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; (S.C.); (L.A.); (D.F.); (V.M.); (S.M.); (L.I.B.); (M.M.); (G.S.); (F.F.)
| |
Collapse
|
5
|
Dabiri Y, Yao J, Mahadevan VS, Gruber D, Arnaout R, Gentzsch W, Guccione JM, Kassab GS. Mitral Valve Atlas for Artificial Intelligence Predictions of MitraClip Intervention Outcomes. Front Cardiovasc Med 2021; 8:759675. [PMID: 34957251 PMCID: PMC8709129 DOI: 10.3389/fcvm.2021.759675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Severe mitral regurgitation (MR) is a cardiac disease that can lead to fatal consequences. MitraClip (MC) intervention is a percutaneous procedure whereby the mitral valve (MV) leaflets are connected along the edge using MCs. The outcomes of the MC intervention are not known in advance, i.e., the outcomes are quite variable. Artificial intelligence (AI) can be used to guide the cardiologist in selecting optimal MC scenarios. In this study, we describe an atlas of shapes as well as different scenarios for MC implantation for such an AI analysis. We generated the MV geometrical data from three different sources. First, the patients' 3-dimensional echo images were used. The pixel data from six key points were obtained from three views of the echo images. Using PyGem, an open-source morphing library in Python, these coordinates were used to create the geometry by morphing a template geometry. Second, the dimensions of the MV, from the literature were used to create data. Third, we used machine learning methods, principal component analysis, and generative adversarial networks to generate more shapes. We used the finite element (FE) software ABAQUS to simulate smoothed particle hydrodynamics in different scenarios for MC intervention. The MR and stresses in the leaflets were post-processed. Our physics-based FE models simulated the outcomes of MC intervention for different scenarios. The MR and stresses in the leaflets were computed by the FE models for a single clip at different locations as well as two and three clips. Results from FE simulations showed that the location and number of MCs affect subsequent residual MR, and that leaflet stresses do not follow a simple pattern. Furthermore, FE models need several hours to provide the results, and they are not applicable for clinical usage where the predicted outcomes of MC therapy are needed in real-time. In this study, we generated the required dataset for the AI models which can provide the results in a matter of seconds.
Collapse
Affiliation(s)
| | - Jiang Yao
- Dassault Systemes Simulia Corp, Johnston, RI, United States
| | - Vaikom S. Mahadevan
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Rima Arnaout
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
- Center for Intelligent Imaging, University of California, San Francisco, San Francisco, CA, United States
- Biological and Medical Informatics, University of California, San Francisco, San Francisco, CA, United States
- Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, United States
| | | | - Julius M. Guccione
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Ghassan S. Kassab
- Department of Medicine, California Medical Innovations Institute, San Diego, CA, United States
| |
Collapse
|
6
|
Tusa MB, Barletta M, Popolo Rubbio A, Travaglio N, Saffioti S, Granata G, Mantovani V, Stefanini E, Corciu AI, Testa L, Bedogni F. Acute changes in mitral valve geometry after percutaneous valve repair with MitraClip XT R by three-dimensional echocardiography. Echocardiography 2021; 38:1913-1923. [PMID: 34755379 DOI: 10.1111/echo.15238] [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: 03/18/2021] [Revised: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mitral valve (MV) repair with MitraClip system is a safe treatment option for high-risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three-dimensional echocardiography (3D-E), changes occurring in MV after implantation of third generation MitraClip XTR device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). METHODS We prospectively enrolled 59 patients, who underwent intra-procedural 3D-E before and after device deployment. Three-D datasets were analyzed off-line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy. RESULTS Post-procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XTR implantation, the FMR group experienced an immediate annular resizing, with reduction of antero-posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle-shape, defined by lower non-planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7, [CI 1.01-44.33], p 0.049). CONCLUSIONS MitraClip XTR implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three-D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success.
Collapse
Affiliation(s)
- Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicole Travaglio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Saffioti
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppina Granata
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Mantovani
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anca I Corciu
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| |
Collapse
|
7
|
Kreidel F, Zaid S, Tamm AR, Ruf TF, Beiras-Fernandez A, Reinold J, Geyer M, da Rocha E Silva J, Schnitzler K, Michaela H, Münzel T, Tang GHL, von Bardeleben RS. Impact of Mitral Annular Dilation on Edge-to-Edge Therapy With MitraClip-XTR. Circ Cardiovasc Interv 2021; 14:e010447. [PMID: 34304600 DOI: 10.1161/circinterventions.120.010447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Felix Kreidel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Syed Zaid
- Department of Cardiology, Westchester Medical Center, Valhalla, NY (S.Z.)
| | - Alexander R Tamm
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Tobias F Ruf
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Andres Beiras-Fernandez
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jenny Reinold
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Jaqueline da Rocha E Silva
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Katharina Schnitzler
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Hell Michaela
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, NY (G.H.L.T.)
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, University Medical Center Mainz, Germany (F.K., A.R.T., T.F.R., A.B.-F., J.R., M.G., J.d.R.e.S., K.S., H.M., T.M., R.S.v.B.)
| |
Collapse
|
8
|
Recurrence of Functional Versus Organic Mitral Regurgitation After Transcatheter Mitral Valve Repair: Implications from Three-Dimensional Echocardiographic Analysis of Mitral Valve Geometry and Left Ventricular Dilation for a Point of No Return. J Am Soc Echocardiogr 2021; 34:744-756. [DOI: 10.1016/j.echo.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 02/07/2021] [Accepted: 02/07/2021] [Indexed: 11/21/2022]
|
9
|
Wang L, Xi J, Cao Q, Jia Y, Zhang Z, Zhang J, Miao G. The Effect of Echocardiography Based on Lipid Nano Contrast Agent on Cardiology Patients with Heart Failure and Atrial Fibrillation. JOURNAL OF NANOSCIENCE AND NANOTECHNOLOGY 2021; 21:852-858. [PMID: 33183416 DOI: 10.1166/jnn.2021.18687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper discusses the effect and evaluation of echocardiography based on lipid nano contrast agent on patients with heart failure and atrial fibrillation in cardiology department, providing reference for clinical diagnosis and treatment. Fifty two patients with diastolic heart failure diagnosed by echocardiography were selected for routine echocardiographic examination after optimizing the drug treatment scheme, and then the patients underwent treadmill exercise test and stress echocardiography evaluation. The results of conventional echocardiography and stress echocardiography after treatment were compared with those before treatment, and the clinical parameters and biochemical indexes before and after treatment were compared. Results after treatment, the clinical symptoms of the patients improved, the level of NT proBNP in the N-terminal forebrain decreased significantly, and the exercise tolerance increased significantly. Compared with the conventional echocardiography before and after treatment, the left ratio and e' value of stress echocardiography after treatment increased significantly, while E/e' decreased significantly. There was no significant difference in the indexes of general echocardiography before and after treatment. After treatment, positively correlated with the ratio of peak a to peak E. The results show that the sensitivity of stress echocardiography to evaluate ischemic diastolic heart failure has been improved, and some indexes have clinical significance. Compared with conventional echocardiography, it can effectively evaluate the therapeutic effect of drugs.
Collapse
Affiliation(s)
- Lizhong Wang
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Jianing Xi
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Qian Cao
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Yaowen Jia
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Zhenying Zhang
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Jianxiu Zhang
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
| | - Guobin Miao
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, China
| |
Collapse
|
10
|
Cimino S, Maestrini V, Cantisani D, Petronilli V, Filomena D, Mancone M, Sardella G, Benedetti G, Fedele F, Agati L. Mid-term repair durability after MitraClip implantation in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2020; 20:701-708. [PMID: 31343448 DOI: 10.2459/jcm.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to identify variables that are associated with the durability of percutaneous repair of secondary mitral regurgitation at 6-month follow-up. METHODS AND RESULTS Thirty-five consecutive patients with functional mitral regurgitation scheduled for MitraClip implant were enrolled. Left ventricular (LV) volumes and function and mitral valve characteristics were assessed before and immediately after MitraClip implantation using three-dimensional transesophageal echocardiography. Five patients with an unsuccessful procedure were excluded. The other patients were subdivided according to repair durability: group 1 with a durable repair (19 patients, 65%) and group 2 with significant mitral regurgitation recurrence (11 patients, 35%). At baseline, group 1 patients had smaller and more elliptical mitral valve annulus (1055 ± 241 vs. 1273 ± 359 mm, P = 0.02 and 125 ± 11 vs. 117 ± 16%, P = 0.02), a smaller left atrial volume (54.1 ± 26 vs. 71.5 ± 20 ml, P = 0.005) and lower systolic pulmonary artery pressure (38 ± 11 vs. 49 ± 12 mmHg, P = 0.03). Baseline LV end systolic volume had a linear correlation with the 3D annulus area (P = 0.048) and an inverse correlation with annulus ellipticity (P = 0.021). Group 1 patients showed an increase in annulus ellipticity after MitraClip (125 ± 17 vs. 141 ± 23%, P = 0.014). CONCLUSION Percutaneous mitral valve repair leads to a significant and stable mitral regurgitation reduction in a large number of patients. Annulus dimensions and remodeling as well as left atrial area and pulmonary hypertension seem to be associated with durability of the procedure.
Collapse
|
11
|
Donmez E, Salcedo EE, Quaife RA, Burke JM, Gill EA, Carroll JD. The acute effects of edge‐to‐edge percutaneous mitral valve repair on the shape and size of the mitral annulus and its relation to mitral regurgitation. Echocardiography 2019; 36:732-741. [DOI: 10.1111/echo.14284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/28/2018] [Accepted: 01/24/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Esra Donmez
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
- Department of CardiologyTurkish Ministry of Health Bakirkoy Dr. Sadi Konuk Training and Research Hospital Bakirkoy, Istanbul Turkey
| | - Ernesto E. Salcedo
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Robert A. Quaife
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Joseph M. Burke
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - Edward A. Gill
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| | - John D. Carroll
- Division of CardiologyUniversity of Colorado HospitalAnschutz Medical CenterUniversity of Colorado School of Medicine Aurora Colorado
| |
Collapse
|
12
|
Mantegazza V, Pasquini A, Agati L, Fusini L, Muratori M, Gripari P, Ghulam Ali S, Vignati C, Bartorelli AL, Ferrari C, Alamanni F, Pepi M, Tamborini G. Comprehensive Assessment of Mitral Valve Geometry and Cardiac Remodeling With 3-Dimensional Echocardiography After Percutaneous Mitral Valve Repair. Am J Cardiol 2018; 122:1195-1203. [PMID: 30082038 DOI: 10.1016/j.amjcard.2018.06.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 01/01/2023]
Abstract
MitraClip is a validated treatment for significant mitral regurgitation (MR) in high-risk patients. Aims of the study were to evaluate immediate changes in mitral valve (MV) geometry induced by MitraClip and correlations between baseline geometry and cardiac remodeling. Eighty patients who underwent MitraClip for primary (48%) or secondary (52%) MR were enrolled. Intraoperative transesophageal echocardiographic 3D images were acquired immediately before and after the procedure for MV annulus (MVA) morphology analysis. Transthoracic 3D echocardiography was performed preoperatively and at 6 months follow-up (6MFU). Patients were classified on the basis of MR reduction (ΔMR) at 6MFU as Optimal (ΔMR ≥ 2) or Suboptimal (ΔMR < 2). An optimal result was reached in 60 (75%) patients, whereas 20 subjects showed a ΔMR< 2 at 6MFU. The Optimal showed significantly smaller baseline MVA (antero-posterior diameter 4.05 ± 0.59 vs 4.43 ± 0.68 cm; anterolateral-posteromedial diameter 4.38 ± 0.56 vs 4.70 ± 0.73 cm; MVA circumference 14.1 ± 1.7 vs 15.1 ± 2.3 cm; and 3D area 14.8 ± 3.9 vs 17.4 ± 5.3 cm2), lower sphericity index and nonplanar angle compared with Suboptimal. A value of antero-posterior diameter ≥4.44cm was identified (receiver-operating characteristic curve) as a possible cut-off for preoperative identification of Suboptimal patients. Postoperatively, MitraClip induced reduction of MVA flattening (nonplanar angle), sphericity index, and size (as expressed by antero-posterior diameter, MVA circumference and area). At 6MFU, the Optimal showed significant decrease in left ventricular volumes and pulmonary artery systolic pressure. In conclusion, MitraClip induces remarkable changes in MVA geometry and favorable left ventricular remodeling is detected in patients with optimal mid-term outcome; a preprocedural antero-posterior diameter <4.44cm seems to be a potential predictor of mid-term optimal result.
Collapse
|
13
|
Utsunomiya H, Itabashi Y, Kobayashi S, Yoshida J, Ikenaga H, Rader F, Hussaini A, Makar M, Trento A, Siegel RJ, Kar S, Shiota T. Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications. Eur Heart J Cardiovasc Imaging 2018; 20:455-466. [DOI: 10.1093/ehjci/jey117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/01/2018] [Accepted: 07/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiroto Utsunomiya
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Yuji Itabashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Sayuki Kobayashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Jun Yoshida
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Hiroki Ikenaga
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Asma Hussaini
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Alfredo Trento
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| |
Collapse
|
14
|
Colli A, Besola L, Montagner M, Soriani N, Manzan E, Bizzotto E, Zucchetta F, Azzolina D, Bellu R, Sarais C, Pittarello D, Gerosa G. Acute intraoperative echocardiographic changes after transapical off-pump mitral valve repair with NeoChord implantation. Int J Cardiol 2018; 257:230-234. [DOI: 10.1016/j.ijcard.2018.01.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/22/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
|
15
|
Herbrand T, Eschenhagen S, Zeus T, Kehmeier E, Hellhammer K, Veulemans V, Kelm M, Balzer J. Acute reverse annular remodeling during MitraClip ® therapy predicts improved clinical outcome in heart failure patients: a 3D echocardiography study. Eur J Med Res 2017; 22:33. [PMID: 28931437 PMCID: PMC5607606 DOI: 10.1186/s40001-017-0273-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip® therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients. METHODS TMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip® implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software. Patients underwent clinical and echocardiographic evaluation at baseline and after 6 months. At follow-up, the patients were allocated into two groups according to their improvement in New York Heart Association (NYHA) functional class: a Low Responder group with ΔNYHA <1.5 (n = 25); and a High Responder group with ΔNYHA ≥1.5 (n = 20). RESULTS At 6-month follow-up, data analysis revealed that while mitral regurgitation was reduced significantly in both groups, only the High Responder group had experienced significant downsizing of the 3D circumference (137 ± 14 mm to 126 ± 13 mm; p < 0.01) and the anterior-to-posterior diameter (33 ± 5 mm to 29 ± 4 mm; p < 0.01) of the mitral annulus during the intervention. Furthermore, only the High Responder group with reverse annular remodeling as shown had substantial advances in quality of life (Minnesota living with heart failure questionnaire: 55 ± 10 to 34 ± 14 points; p < 0.01) and functional status (6-min walk distance: 290 ± 104 m to 462 ± 111 m; p = 0.07). CONCLUSION Our study demonstrates that instantaneous left ventricular annular remodeling during MitraClip® implantation is associated with improved clinical outcome of heart failure patients with functional mitral regurgitation. Trial registration The study was approved by the local ethics committee (Study Number 4497R, Registration ID: 2013121585). TRIAL REGISTRATION NCT02033811 Retrospectively registered January 9, 2014.
Collapse
Affiliation(s)
- Theresa Herbrand
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Silke Eschenhagen
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Tobias Zeus
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Eva Kehmeier
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Katharina Hellhammer
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Verena Veulemans
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Malte Kelm
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Jan Balzer
- Department of Medicine, Division of Cardiology, Pneumology, and Angiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| |
Collapse
|
16
|
Cilingiroglu M, Marmagkiolis K. Invasive Hemodynamic Assessment During Mitra-Clip Implantation. Catheter Cardiovasc Interv 2016; 88:1143-1144. [DOI: 10.1002/ccd.26868] [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] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Mehmet Cilingiroglu
- Koc University, School of Medicine; Istanbul Turkey
- University of Arkansas for Medical Sciences; Little Rock, AR USA
| | | |
Collapse
|