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. 2019 Jan 1;93(1):156-163.
doi: 10.1002/ccd.27831. Epub 2018 Sep 23.

Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Guilherme Rafael Sant'Anna Athayde  1   2 , Bruno Ramos Nascimento  2 , Sammy Elmariah  3   4 , Lucas Lodi-Junqueira  2 , Juliana Rodrigues Soares  1   2 , Gabriel Prado Saad  2 , Jose Luiz Padilha da Silva  5 , Timothy C Tan  6 , Judy Hung  6 , Igor F Palacios  3   4 , Robert A Levine  6 , Maria Carmo Pereira Nunes  1   2
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Impact of left atrial compliance improvement on functional status after percutaneous mitral valvuloplasty

Guilherme Rafael Sant'Anna Athayde et al. Catheter Cardiovasc Interv. .

Abstract

Background: Conventional hemodynamic parameters may not accurately predict symptomatic improvement after percutaneous mitral valvuloplasty (PMV). Changes in left heart chamber compliance following adequate relief o0066 mitral stenosis (MS) may be useful in determining functional capacity after PMV. This study aims to determine the acute effects of PMV on compliance of the left heart and whether its changes relate to the patient's functional capacity.

Methods: One-hundred thirty-seven patients with severe MS undergoing PMV were enrolled. Left atrial (Ca ) and left ventricular (Cv ) compliance were invasively estimated and net atrioventricular compliance (Cav ) was calculated before and immediately after the procedure. B-type natriuretic peptide (BNP) levels were obtained before and 24 hr after the procedure. The primary endpoint was functional status at 6-month follow-up, and the secondary endpoint was a composite of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, or stroke in patients in whom PMV was successful.

Results: The mean age was 43 ± 12 years, and 119 patients were female (87%). After PMV, Ca and Cav improved significantly from 5.3 [IQR 3.2-8.2] mL/mmHg to 8.7 [5.3-19.2] mL/mmHg (P < 0.001) and 2.2 [1.6-3.4] to 2.8 [2.1-4.1] mL/mmHg (P < 0.001), respectively, whereas Cv did not change (4.6 [3.2-6.8] to 4.4 [3.1-5.6]; P = 0.637). Plasma BNP levels significantly decreased after PMV, with no correlation between its variation and changes in left chamber compliance. At 6-month follow-up, NYHA functional class remained unchanged in 32 patients (23%). By multivariable analyses, changes in Ca immediately after PMV (adjusted OR 1.42; 95% CI 95% 1.02 to 1.97; P = 0.037) and younger age (adjusted OR 0.95; CI 95% 0.92-0.98; P = 0.004), predicted improvement in functional capacity at 6-month follow-up, independent of postprocedural data. The secondary endpoint were predicted by post-PMV mean gradient (adjusted HR 1.363; 95% CI 95% 1.027-1.809; P = 0.032), and lack of functional improvement at 6-month follow-up (adjusted HR 4.959; 95% 1.708-14.403; P = 0.003).

Conclusions: Ca and Cav increase significantly after PMV with no change in Cv . The improvement of Ca is an important predictor of functional status at 6-month follow up, independently of other hemodynamic data. Postprocedural mean gradient and lack of short-term symptomatic improvement were predictors of adverse outcome.

Keywords: atrial compliance; functional capacity; mitral stenosis; net atrioventricular compliance; percutaneous mitral valvuloplasy; ventricular compliance.

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Figures

FIGURE 1
FIGURE 1
Simultaneous LA and LV pressure recordings of a patient preprocedure and postprocedure procedure used for measurement of left chamber compliance. The changes in LA and LV pressures were used to calculate mean LA and LV compliance before and after valvuloplasty
FIGURE 2
FIGURE 2
Changes in LA compliance immediately after PMV and NYHA functional class at 6 month follow-up. Erros bars represent error standard error
FIGURE 3
FIGURE 3
Cumulative incidence of adverse events in patients with functional capacity improvement compared to unchanged functional capacity. Adverse events were defined as death, MV replacement, repeat PMV, new onset of atrial fibrillation, and stroke. Abbreviation: FC, functional capacity
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