Distinct Hemodynamic Changes After Interventional Mitral Valve Edge-to-Edge Repair in Different Phenotypes of Heart Failure: An Integrated Hemodynamic Analysis
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Distinct Hemodynamic Changes After Interventional Mitral Valve Edge-to-Edge Repair in Different Phenotypes of Heart Failure: An Integrated Hemodynamic Analysis. / Schrage, Benedikt; Kalbacher, Daniel; Schwarzl, Michael; Rübsamen, Nicole; Waldeyer, Christoph; Becher, Peter Moritz; Tigges, Eike; Burkhoff, Daniel; Blankenberg, Stefan; Lubos, Edith; Schäfer, Ulrich; Westermann, Dirk.
in: J AM HEART ASSOC, Jahrgang 7, Nr. 6, e007963, 15.03.2018.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Distinct Hemodynamic Changes After Interventional Mitral Valve Edge-to-Edge Repair in Different Phenotypes of Heart Failure: An Integrated Hemodynamic Analysis
AU - Schrage, Benedikt
AU - Kalbacher, Daniel
AU - Schwarzl, Michael
AU - Rübsamen, Nicole
AU - Waldeyer, Christoph
AU - Becher, Peter Moritz
AU - Tigges, Eike
AU - Burkhoff, Daniel
AU - Blankenberg, Stefan
AU - Lubos, Edith
AU - Schäfer, Ulrich
AU - Westermann, Dirk
N1 - © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2018/3/15
Y1 - 2018/3/15
N2 - BACKGROUND: Percutaneous mitral valve edge-to-edge repair (pMVR) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction (EF). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure-volume loops to investigate the left ventricular (LV) remodeling of patients after pMVR dependent on their baseline EF.METHODS AND RESULTS: In 130 patients with successful pMVR, the end-diastolic pressure-volume relationship (EDPVR) and end-systolic pressure-volume relationship were estimated noninvasively from echocardiographic data. We compared EDPVR and end-systolic pressure-volume relationship at discharge and follow-up between patients with a reduced EF (<40%) and patients with a mid-ranged or preserved EF (≥40%). Reduced EF was present in 71 patients (54%). Mean follow-up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow-up irrespective of baseline EF. In patients with a mid-ranged or preserved EF, the EDPVR and end-systolic pressure-volume relationship were shifted leftwards, suggesting an improvement in LV function. In contrast, in patients with a reduced EF, EDPVR and end-systolic pressure-volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the EDPVR. This indicates that there is no improvement in LV function after pMVR in patients with reduced EF.CONCLUSIONS: The pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid-ranged or preserved EF, we found reverse remodeling with reduced LV dilatation and increased contractility. In contrast, in patients with reduced EF, we observed no reverse remodeling and no improvement in LV function.
AB - BACKGROUND: Percutaneous mitral valve edge-to-edge repair (pMVR) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction (EF). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure-volume loops to investigate the left ventricular (LV) remodeling of patients after pMVR dependent on their baseline EF.METHODS AND RESULTS: In 130 patients with successful pMVR, the end-diastolic pressure-volume relationship (EDPVR) and end-systolic pressure-volume relationship were estimated noninvasively from echocardiographic data. We compared EDPVR and end-systolic pressure-volume relationship at discharge and follow-up between patients with a reduced EF (<40%) and patients with a mid-ranged or preserved EF (≥40%). Reduced EF was present in 71 patients (54%). Mean follow-up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow-up irrespective of baseline EF. In patients with a mid-ranged or preserved EF, the EDPVR and end-systolic pressure-volume relationship were shifted leftwards, suggesting an improvement in LV function. In contrast, in patients with a reduced EF, EDPVR and end-systolic pressure-volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the EDPVR. This indicates that there is no improvement in LV function after pMVR in patients with reduced EF.CONCLUSIONS: The pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid-ranged or preserved EF, we found reverse remodeling with reduced LV dilatation and increased contractility. In contrast, in patients with reduced EF, we observed no reverse remodeling and no improvement in LV function.
KW - Aged
KW - Aged, 80 and over
KW - Cardiac Surgical Procedures
KW - Echocardiography, Doppler, Pulsed
KW - Female
KW - Heart Failure/diagnostic imaging
KW - Hemodynamics
KW - Humans
KW - Male
KW - Mitral Valve/diagnostic imaging
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Myocardial Contraction
KW - Phenotype
KW - Recovery of Function
KW - Registries
KW - Retrospective Studies
KW - Stroke Volume
KW - Time Factors
KW - Treatment Outcome
KW - Ventricular Function, Left
KW - Ventricular Pressure
KW - Ventricular Remodeling
U2 - 10.1161/JAHA.117.007963
DO - 10.1161/JAHA.117.007963
M3 - SCORING: Journal article
C2 - 29545259
VL - 7
JO - J AM HEART ASSOC
JF - J AM HEART ASSOC
SN - 2047-9980
IS - 6
M1 - e007963
ER -