Acute effect of edge-to-edge repair of mitral regurgitation on left heart mechanics and health status

Richard Ro, Francesca R. Prandi, Syed Zaid, Malcolm O. Anastasius, Gilbert H.L. Tang, Karthik Seetharam, Edgar Argulian, Gianluca Massaro, Samin Sharma, Annapoorna Kini, Stamatios Lerakis

Research output: Contribution to journalArticlepeer-review

Abstract

AimsExamine the impact of acute changes in left heart strain and volumes with percutaneous edge-to-edge MitraClip repair on improvement in health status assessed using Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score.MethodsChanges in left atrial strain, left ventricular (LV) global longitudinal strain (LVGLS), LV end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were evaluated in 50 patients undergoing MitraClip repair for symptomatic primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) on transthoracic echocardiography before and 1 month after MitraClip. Multivariable regression was used to evaluate changes in left heart strain and volumes as predictors of change in KCCQ-12 scores, adjusting for baseline clinical and echocardiographic characteristics.ResultsBoth PMR and SMR patients had significant increase in LVGLS and reduction in LVEDV and LVESV (P<0.05) after MitraClip, reduction trend in left atrial conduit strain (PMR P=0.053; SMR P=0.12) but no significant change in LV ejection fraction. KCCQ-12 score improved significantly in both PMR (P<0.001) and SMR cohorts (P<0.001). Higher delta KCCQ-12 tertiles were associated with greater reduction in LVEDV (P=0.022) after MitraClip. On multiple regression analysis, lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial strain conduit phase were associated with KCCQ-12 score improvement (P<0.001).ConclusionThere is a significant increase in LVGLS and reduction in LVEDV, LVESV and left atrial strain conduit after edge-to-edge MitraClip repair in both PMR and SMR. Lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial conduit strain were associated with KCCQ-12 score improvement after MitraClip. Further studies are warranted to understand the mechanism and significance of our findings.

Original languageEnglish
Pages (from-to)787-797
Number of pages11
JournalJournal of Cardiovascular Medicine
Volume23
Issue number12
DOIs
StatePublished - 1 Dec 2022

Keywords

  • MitraClip
  • mitral regurgitation
  • strain imaging
  • transcatheter edge-to-edge repair

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