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. 2020 Sep 1;96(3):687-697.
doi: 10.1002/ccd.28779. Epub 2020 Feb 27.

Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system

Nicoleta Nita  1 , Dominik Scharnbeck  1 , Leonhard-Moritz Schneider  1 , Julia Seeger  1 , Jochen Wöhrle  1 , Wolfgang Rottbauer  1 , Mirjam Keßler  1 , Sinisa Markovic  1
Affiliations

Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system

Nicoleta Nita et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR).

Background: MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited.

Methods: This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients.

Results: LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio [OR] = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361).

Conclusions: LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.

Keywords: edge-to-edge repair; left ventricle; mitral valve; recurrent mitral regurgitation; reverse remodeling; tricuspid regurgitation.

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References

REFERENCES

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