Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

Background

Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR.

Methods

We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.

Results

93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed.

Conclusion

PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.

Proportion of patients who presented ven

Funding Acknowledgement

Type of funding source: None

Successful treatment of vasospastic angina with a coronary stent

Calcium antagonists are the treatment of choice in vasospasm angina when no stenosis or mild stenosis are present. We present a case in which ergonovine echocardiography showed vasospasm of the right coronary artery despite optimal medical treatment. Stenting of a mild stenosis in that artery successfully controlled vasospasm and a pre-discharge ergonovine echocardiographic test was negative. The patient remains asymptomatic one year after stenting.

[The influence of sex on the performance of dobutamine echocardiography for the diagnosis of ischemic cardiopathy]

OBJECTIVE

To compare the usefulness of dobutamine-atropine stress echocardiography in the diagnosis of coronary artery disease among men and women.

METHODS

We have consecutively studied 137 men and 99 women without a previous history of coronary artery disease who underwent dobutamine-atropine stress echocardiography and coronary angiography afterwards.

RESULTS

Significant coronary artery disease was detected in 102 men and 42 women (74% and 42% respectively; p < 0.001). 64% of the women had single-vessel versus 45% of the men (p < 0.05). Dobutamine-atropine stress echocardiography was positive in 78 men and 35 women. Sensitivity, specificity and diagnostic accuracy of the test were 72%, 88% and 76% for men and 69%, 89% and 83% for women (p = NS). Positive predictive value was higher in men (95% in men versus 83% in women; p < 0.05) and negative predictive value was significantly greater in women than in men (79% versus 52%; p < 0.01).

CONCLUSION

Sensitivity, specificity and diagnostic accuracy of dobutamine-atropine stress echocardiography is not affected by gender. Positive predictive value is higher in men and negative in women owing to the differences in both sexes of the prevalence of coronary artery disease.