Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.
J Cardiovasc Dev Dis
; 10(3)2023 Feb 25.
Article
en En
| MEDLINE
| ID: mdl-36975864
ABSTRACT
BACKGROUND:
The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and LV remodeling in patients with severe primary mitral regurgitation (PMR).METHODS:
A total of 71 patients (age 77 ± 9 years, females 44%) with moderate-to-severe or severe PMR (effective regurgitant orifice 0.57 ± 0.31 cm2; regurgitant volume 80 ± 34 mL; LV end-systolic diameter 42 ± 12 mm) underwent TEER after a global assessment by the heart team. MW indices were evaluated before the procedure, at hospital discharge, and at 1-year follow-up. LV remodeling was described as the percentage variation in LVEDV between baseline and 1-year follow-up.RESULTS:
TEER caused an acute reduction in LVEF, global longitudinal strain (GLS), global MW index (GWI), work efficiency (GWE), and mechanical dispersion (MD) and a significant increase in wasted work (GWW). One year after the procedure, GLS, GWI, GWE, and MD recovered, whereas GWW remained significantly impaired. Baseline GWW (ß = -0.29, p = 0.03) was an independent predictor of LV reverse remodeling at 1-year follow-up.CONCLUSIONS:
In patients with severe PMR undergoing TEER, the acute reduction in LV preload causes significant impairment to all the parameters of LV performance. Baseline GWW was the only independent predictor of LV reverse remodeling, suggesting that a lower myocardial energetic efficiency in the context of chronic preload increase might impact the left ventricular response to mitral regurgitation correction.
Texto completo:
1
Bases de datos:
MEDLINE
Idioma:
En
Revista:
J Cardiovasc Dev Dis
Año:
2023
Tipo del documento:
Article
País de afiliación:
Francia