Key result
MitraClip significantly increased left atrial end-diastolic volume (83.1 to 115.1 ml, p=0.012) and stroke volume in patients with functional mitral regurgitation.
Why the study?
Exact left atrial alterations following interventional reduction of mitral regurgitation with MitraClip in patients with functional mitral regurgitation were unknown.
Does MitraClip alter left atrial volumes and global function in high-risk patients with functional mitral regurgitation?
Cohort (n=50)
Does MitraClip alter left atrial volumes and global function in high-risk patients with functional mitral regurgitation?
Absolute Event Rate: 115.1% vs 83.1%
p-value: p=0.012
In patients with functional mitral regurgitation, MitraClip increases left atrial volumes and mass without improving atrial global strain, though baseline strain serves as a strong predictor of adverse clinical outcomes.
Raises caution regarding left atrial remodeling after MitraClip; leaves open effects on atrial function and outcomes in functional MR.
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.
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Öztürk et al. (2020) conducted a cohort in functional mitral regurgitation (n=50). MitraClip vs. Baseline was evaluated on Left atrial end-diastolic volume (LA-EDV) (p=0.012). MitraClip significantly increased left atrial end-diastolic volume (83.1 to 115.1 ml, p=0.012) and stroke volume in patients with functional mitral regurgitation.
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