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Influence of successful reduction of mitral regurgitation on left ventricular function after interventional edge-to-edge repair of functional mitral regurgitation.

Session Poster session 5

Speaker Maximilian Von Roeder

Congress : EuroEcho-Imaging 2018

  • Topic : imaging
  • Sub-topic : Echocardiography: Valve Disease
  • Session type : Poster Session
  • FP Number : P1486

Authors : MDW Von Roeder (Leipzig,DE), S Blazek (Leipzig,DE), KP Rommel (Leipzig,DE), C Besler (Leipzig,DE), K Fengler (Leipzig,DE), J Seeburger (Leipzig,DE), T Noack (Leipzig,DE), H Thiele (Leipzig,DE), P Lurz (Leipzig,DE)

MDW Von Roeder1 , S Blazek1 , KP Rommel1 , C Besler1 , K Fengler1 , J Seeburger2 , T Noack2 , H Thiele1 , P Lurz1 , 1University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology - Leipzig - Germany , 2University of Leipzig, Heart Center, Department of Cardiac Surgery - Leipzig - Germany ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i1060

Background: The evidence regarding the influence of interventional edge-to-edge repair (Mitraclip®-Implantation, MC) of functional mitral regurgitation (MR) on left ventricular (LV) function is conflicting and some studies show an improvement of LV function while others do not, but previous studies did not report results according to MR reduction. The degree of MR reduction could be of influence by alleviating chronic volume overload. Aim of the current study was to investigate acute and chronic changes of LV structure and function according to MR reduction following MC.

Methods: We performed 2-D echocardiography, Doppler echocardiography and 2-D LV strain analysis in 25 patients with severe functional MR before and after (mean 3.6±2.3 days) MC and at follow up (FU, mean 172±70 days). Patients were grouped as having strong MR reduction (MR-, MR =1, n=14) on FU or as having less MR reduction (MR+, MR>1, n=11). Repeated measures ANOVA was used to reveal changes between pre- and postinterventional parameters and parameters on FU.

Results: Baseline characteristics were well balanced between both groups (mean age 74±8 years, 40% female, 52% ischemic cardiomyopathy, 72% atrial fibrillation) as well as echocardiographic parameters (mean LV-EF 38±3%, LV end diastolic volume (EDV) 116±39 ml/m², global longitudinal strain (GLS) -9.1±4.9%, left atrial end-systolic volume index (LAESVI) 65±21 ml/m²). Two clips were implanted in 43% of MR- patients and 18% of MR+ patients (p=0.23).

No changes in LVEDV were observed in MR+ patients (pre 106 ± 33, post 107 ± 28, FU 111 ± 24ml/m², p=0.77) while MR- patients showed a lower LVEDV on FU (pre 123 ± 43, post 119 ± 46, FU 111 ± 46ml/m², p=0.01 pre vs FU). LVEF and GLS dropped postinterventional in MR-, but recovered to previous level on FU (LVEF pre 40±15, post 31±12, FU 38±13%, p=0.001 pre vs post and post vs FU; GLS pre -9.1±5.6, post -7.3±5.1, FU -10.0±5.4, p=0.001 pre vs post and post vs FU). In MR+ patients LVEF remained unchanged postinterventional but showed a significant drop on FU as compared to preinterventional (pre 37±11, post 36±10, FU 32±7%, p=0.02 pre vs FU) and GLS dropped immediately postinterventional with further deterioration on FU (pre -9.1±4.1, post -8.1±3.7, FU -7.9±2.7, p=0.04 pre vs FU). No correlation between the number of implanted clips and changes in GLS or LVEF could be found (p=n.s.).

Conclusion: In patients with functional MR and moderately to severely depressed LV function treated with percutaneous mitral valve repair, MR reduction to grade =1 leads to acute dropping in LV function -most likely due to preload reduction- with recuperation on follow up while patients without significant MR reduction experience further decline in LV function on follow up.

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