Transcatheter mitral valve repair in proportionate and disproportionate functional mitral regurgitation—insights from a small cohort study

Figures

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  Fig. 1. Determining patient-specific proportionality of functional mitral regurgitation. Graph plotting the FMR regurgitant volume vs LVEDV. The black line shows the eRegVol for each given LVEDV at an LVEF of 30% and a regurgitant fraction of 50% (eRegVol = LVEDV × LVEF × 0.50). A margin of ±6.6% was instated (dotted lines). Any measured value of regurgitant volume within the red, grey or green zone are deemed disproportionate, proportionate or non-severe respectively. Of note, the reference line shifts for different, individual, values of LVEF. Details on used formulas are found in Appendix I in the Electronic Supplementary Material (ESM). FMR functional mitral regurgitation, LVEDV left ventricular end-diastolic volume, LVEF left ventricular ejection fraction, eRegVol expected regurgitant volume

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  Fig. 2. Patient identification. Flow chart of the patient identification process showing that only a small percentage of patients in the prospective Mitraclip database was suitable for determination of proportionality. EROA effective regurgitant orifice area, LVEDV left ventricular end-diastolic volume, LVEF left ventricular ejection fraction, RegVol regurgitant volume

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  Fig. 3. Functional mitral regurgitation severity and proportionality. Scatter plot depicting individual values of FMR regurgitant volume vs LVEDV at baseline. FMR proportionality was determined for 3 different groups of LVEF based on LVEF median and interquartile range (bubble size large, medium and small size depict an LVEF of > 30%, 21–30% and < 21% respectively). Each individual FMR was classified as either disproportionate (red) or proportionate (blue). Patients with FMR reduction are depicted as a dot and patients without reduction are displayed as a cross. Dot/cross size is coded according to LVEF. FMR functional mitral regurgitation, LVEDV left ventricular end-diastolic volume, LVEF left ventricular ejection fraction