Aims: Percutaneous mitral valve repair (PMVR) for mitral regurgitation (MR) can be performed with the MitraClip System. Our aim was to assess the changes of right ventricular (RV) after Mitraclip in patients with functional MR. Methods and results: Between November 2009 and December 2012, 44 patients affected by severe functional MR underwent PMVR with the MitraClip. Patients who didn't undergo successful Mitraclip implantation were excluded from the analysis. Therefore, the study population included 35 patients. Median age was 75 years (63-81), 65.7% (n=23) were male with a median logistic EuroSCORE of 20%. Patients with MR grade ≥3+ were 5.7% and 11.4% at discharge and 6 months, respectively (p<0.0001) versus 100% at baseline, with a clinical benefit in NYHA class (p<0.0001). BNP plasma levels revealed a significant overall decrease at follow-up (from 61.1±16.5 to 32.9±18.4; P<0.0001). Improvements in left ventricular (LV) size and function were observed. At baseline, before discharge and 6-months, respectively, the LV end-diastolic diameter was 66.1±11.2mm, 63.6±10.8mm and 61.6±11.3mm (p<0.0001), the LV end-diastolic volume 191.4±73.7ml, 174.2±72.3ml and 152.9±73.1ml (p<0.0001), the LV ejection fraction 36.5±11.3%, 39.2±9.7% and 41.8±10.5% (p<0.0001). During follow-up, an improvement in the RV function was also observed. At baseline, before discharge and 6-months, respectively, the tricuspid annulus plane systolic excursion (TAPSE) was 16.8±3.9mm, 18.7±3.4mm and 19.3±4.5mm (p=0.001), the systolic pulmonary artery pressure (SPAP): 50.1±6.8mmHg, 41.2±6.8 mmHg and 38.1±6.8 mmHg (p<0.0001), the systolic velocity at the tricuspid annular (RV-Sm): 8.8±2.9 cm, 10.4±3.5 cm and 117.7±3.1 cm (p<0.0001). Moreover, we observed right atrial (RA) reverse remodeling with significant decrease in RA area (p<0.0001). A significant inverse correlation was observed between baseline NYHA class and TAPSE (r = -0.36, P = 0.03) while a significant positive correlation was seen between baseline MR grade and 6-months TAPSE (r = 0.44, P = 0.03). 6-months TAPSE improvement correlated significantly with improvements in NYHA class (r = -0.41, P = 0.05). Conclusion: MitraClip implantation has induced a significant reduction of LV volume overload. The concomitant reduction of LV filling pressure, after Mitraclip implantation, reflected nearly immediately on clinical profile and on hemodynamics of the right sections. In fact, since discharge, we observed both a significant reduction of SPAP and a significant increase of longitudinal RV systolic function as shown by the increase of TAPSE and RV-Sm.
|Titolo:||Echocardiographic evaluation of right ventricular function after MitraClip implantation in functional mitral regurgitation|
|Anno del prodotto:||2013|
|Appare nelle tipologie:||4.2 Abstract in Atti di convegno|