Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair  in Atrial Versus Ventricular Functional Mitral Regurgitation.

Aged; Cardiac Catheterization/methods; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation/methods; Heart Ventricles/diagnostic imaging/physiopathology; Hemodynamics/physiology; Humans; Male; Mitral Valve/diagnostic imaging/physiopathology/surgery; Mitral Valve Insufficiency/diagnosis/physiopathology/surgery; Retrospective Studies; Treatment Outcome

Résumé :

[en] The present study aims to assess the clinical and hemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with atrial functional mitral regurgitation (A-FMR) compared with ventricular functional mitral regurgitation (V-FMR). Mitral regurgitation (MR) grade, functional status (New York Heart Association class), and major adverse cardiac events (MACE; all-cause mortality or hospitalization for heart failure) were evaluated in 52 patients with A-FMR and in 307 patients with V-FMR. In 56 patients, hemodynamic assessment during exercise echocardiography was performed before and 6 months after intervention. MR reduction after MitraClip implantation was noninferior in A-FMR compared with V-FMR (MR grade ≤2 at 6 months in 94% vs 82%, respectively, p <0.001 for noninferiority) and was associated with improvement of functional status (New York Heart Association class ≤2 at 6 months in 90% vs 80%, respectively, p = 0.2). Hemodynamic assessment revealed that cardiac output at 6 months was higher in A-FMR at rest (5.1 ± 1.5 L/min vs 3.8 ± 1.5 L/min, p = 0.002) and during peak exercise (7.9 ± 2.4 L/min vs 6.1 ± 2.1 L/min, p = 0.02). In addition, the reduction in systolic pulmonary artery pressure at rest was more pronounced in A-FMR: Δ SPAP -13.1 ± 15.1 mm Hg versus -2.2 ± 13.3 mm Hg (p = 0.03). MACE rate at follow-up was significantly lower in A-FMR versus V-FMR, with an adjusted odds ratio of 0.46 (95% confidence interval 0.24 to 0.88), which was caused by a reduction in hospitalization for heart failure. In 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. However, the hemodynamic improvement and reduction of MACE were significantly better in A-FMR.

Disciplines :

Systèmes cardiovasculaire & respiratoire

Auteur, co-auteur :

Claeys, Marc J; Dept of cardiology, Antwerp University Hospital, Edegem, Belgium. Electronic

Debonnaire, Philippe; Dept of cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium.

Bracke, Veronique; Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.

Bilotta, Giada; Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.

Shkarpa, Nikol; Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.

Vanderheyden, Marc; Dept of cardiology, OLV Hospital Aalst, Aalst, Belgium.

Coussement, Patrick; Dept of cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium.

Vanderheyden, Jan; Dept of cardiology, Hospital Sint-Jan Brugge, Bruges, Belgium.

de Heyning, Caroline M Van; Dept of cardiology, Antwerp University Hospital, Edegem, Belgium.

Cosyns, Bernard; Dept of cardiology, Brussels University Hospital, Brussels, Belgium.

Plus d'auteurs (5 en +)

Langue du document :

Anglais

Titre :

Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation.

Date de publication/diffusion :

15 décembre 2021

Titre du périodique :

American Journal of Cardiology

ISSN :

0002-9149

eISSN :

1879-1913

Maison d'édition :

Elsevier, New York, Us ny

Volume/Tome :

161

Pagination :

70-75

Peer reviewed :

Peer reviewed vérifié par ORBi

Commentaire :

Disponible sur ORBi :

depuis le 24 mai 2022

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466 (dont 1 ULiège)

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Bibliographie

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