Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip.
Catheter Cardiovasc Interv
; 96(3): 678-684, 2020 09 01.
Article
in En
| MEDLINE
| ID: mdl-32065722
ABSTRACT
BACKGROUND:
Left atrial (LA) volumes and function are believed to improve following interventional reduction of mitral regurgitation (MR) with MitraClip. However, exact LA alterations after MitraClip in patients with functional MR and functional mitral regurgitation (FMR) are unknown.OBJECTIVES:
We aimed to evaluate the effect of MitraClip on LA volumes and global function in patients with FMR and its importance for patients' prognosis.METHODS:
All patients underwent three-dimensionally transthoracic echocardiography with an offline evaluation of LA geometry and strain analysis at baseline and follow-up (FU). FU examinations were planned for 6 and 12 months after MitraClip.RESULTS:
We prospectively included 50 consecutive surgical high-risk (logistic EuroSCORE 17.2 ± 13.9%) patients (77 ± 9 years, 22% female) with symptomatic moderate-to-severe to severe functional MR without atrial fibrillation. Echocardiographic evaluation showed that the E/E' ratio was significantly higher at FU (15.6 ± 7.3, 24.1 ± 13.2, p = .05) without relevant changes in systolic left ventricle (LV) function (p = .5). LA volumes (end-diastolic volume [LA-EDV] and end-systolic volume [LA-ESV]) (LA-EDV 83.1 ± 39.5 ml, 115.1 ± 55.3 ml, p = .012; LA-ESV 58.4 ± 33.4 ml, 80.1 ± 43.9 ml, p = .031), muscular mass (105.1 ± 49.3 g, 145.4 ± 70.6 g, p = .013), as well as LA stroke volume (24.6 ± 12.5 ml, 34.9 ± 19.1 ml, p = .016) significantly increased after the procedure. LA ejection fraction (LA-EF 31.7 ± 12.8%, 31.1 ± 12.3%, p = .8) and atrial global strain (aGS -10.8 ± 5.4%, -9.7 ± 4.45%, p = .4) showed no significant changes at FU. Despite no relevant changes during FU, the baseline aGS was found to be the strongest predictor for mortality and adverse interventional outcome.CONCLUSION:
MitraClip increases atrial stroke volume, atrial volumes, and muscular mass in patients with FMR. We found that the baseline aGS the strongest predictor for mortality, rehospitalization, and higher residual MR at FU.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Heart Valve Prosthesis
/
Cardiac Catheterization
/
Atrial Function, Left
/
Heart Valve Prosthesis Implantation
/
Atrial Remodeling
/
Heart Failure
/
Mitral Valve
/
Mitral Valve Insufficiency
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
Catheter Cardiovasc Interv
Journal subject:
CARDIOLOGIA
Year:
2020
Type:
Article
Affiliation country:
Germany