Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation
| Autor: | Patrick Coussement, Philippe Debonnaire, C M Van De Heyning, Bert Ferdinande, Bernard Cosyns, Marc Vanderheyden, Bernard P. Paelinck, Patrizio Lancellotti, J Vanderheyden, Giada Bilotta, A C Pouleur, Christophe Dubois, Nikol Shkarpa, V Bracke, Marc J. Claeys |
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| Přispěvatelé: | UCL - (SLuc) Service de pathologie cardiovasculaire, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, UCL - (SLuc) Service de cardiologie, Clinical sciences, Cardio-vascular diseases, Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Cardiac output Cardiac Catheterization Percutaneous New York Heart Association Class medicine.medical_treatment heart failure Hemodynamics surgery Atrial Functional Mitral Regurgitation Atrium (heart) Functional mitral regurgitation Heart Valve Prosthesis Implantation MitraClip Mitral Valve Insufficiency medicine.anatomical_structure Treatment Outcome V-FMR Echocardiography cardiovascular system Cardiology Mitral Valve Female Cardiology and Cardiovascular Medicine Cardiovascular event medicine.medical_specialty Ventricular Functional Mitral Regurgitation Heart Ventricles Mitraclip Internal medicine medicine Humans cardiovascular diseases Mortality Aged Retrospective Studies A-FMR Mitral valve repair Mitral regurgitation business.industry MitraClip valve repair medicine.disease Heart failure mitral regurgitation Human medicine business Mace Follow-Up Studies |
| Zdroj: | The American journal of cardiology, Vol. 161, no.Dec 15, p. 70-75 (2021) The American journal of cardiology, Vol. 161, p. 70-75 (2021) The American journal of cardiology Web of Science |
| ISSN: | 0002-9149 |
| Popis: | Background Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function. Purpose To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR. Methods MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention. Results MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization. Conclusion Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts. Funding Acknowledgement Type of funding sources: None. MACE in A-FMR versus V-FMR pts |
| Databáze: | OpenAIRE |
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