Key result
In heart failure patients with functional mitral regurgitation, significant downsizing of the 3D mitral annulus circumference from 137 mm to 126 mm (p<0.01) during MitraClip implantation was associated with improved clinical outcomes at 6 months.
Why the study?
Does acute reverse annular remodeling during MitraClip therapy predict improved clinical outcomes and functional status in heart failure patients with functional mitral regurgitation?
Cohort (n=45)
Single-blind
No
Does acute reverse annular remodeling during MitraClip therapy predict improved clinical outcomes and functional status in heart failure patients with functional mitral regurgitation?
Instantaneous left ventricular annular remodeling (downsizing) during MitraClip implantation is a significant predictor of improved functional status and quality of life at 6 months in heart failure patients with functional mitral regurgitation.
Acute annular remodeling after MitraClip may predict outcomes in FMR; leaves open causal role and need for prospective validation.
Background Transcatheter mitral valve repair (TMVR) has been shown to have acute effects on mitral valve geometry in patients with functional mitral regurgitation (FMR). This study investigates the impact of MitraClip ® therapy-induced annular remodeling on clinical outcome and mitral regurgitation in heart failure patients. Methods TMVR was performed successfully in 45 patients with FMR. In this study, mitral valve datasets were obtained before and directly after MitraClip ® implantation using three-dimensional (3D) transesophageal echocardiography, and were analyzed offline retrospectively using dedicated 3D reconstruction software. Patients underwent clinical and echocardiographic evaluation at baseline and after 6 months. At follow-up, the patients were allocated into two groups according to their improvement in New York Heart Association (NYHA) functional class: a Low Responder group with ΔNYHA <1.5 ( n = 25); and a High Responder group with ΔNYHA ≥1.5 ( n = 20). Results At 6-month follow-up, data analysis revealed that while mitral regurgitation was reduced significantly in both groups, only the High Responder group had experienced significant downsizing of the 3D circumference (137 ± 14 mm to 126 ± 13 mm; p < 0.01) and the anterior-to-posterior diameter (33 ± 5 mm to 29 ± 4 mm; p < 0.01) of the mitral annulus during the intervention. Furthermore, only the High Responder group with reverse annular remodeling as shown had substantial advances in quality of life (Minnesota living with heart failure questionnaire: 55 ± 10 to 34 ± 14 points; p < 0.01) and functional status (6-min walk distance: 290 ± 104 m to 462 ± 111 m; p = 0.07). Conclusion Our study demonstrates that instantaneous left ventricular annular remodeling during MitraClip ® implantation is associated with improved clinical outcome of heart failure patients with functional mitral regurgitation. Trial registration The study was approved by the local ethics committee (Study Number 4497R, Registration ID: 2013121585). Trial registration: NCT02033811 Retrospectively registered January 9, 2014.
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Herbrand et al. (2017) conducted a cohort in Heart failure with functional mitral regurgitation (n=45). Transcatheter mitral valve repair (MitraClip) vs. Low clinical response (ΔNYHA <1.5) was evaluated on Downsizing of the 3D circumference of the mitral annulus (p=<0.01). In heart failure patients with functional mitral regurgitation, significant downsizing of the 3D mitral annulus circumference from 137 mm to 126 mm (p<0.01) during MitraClip implantation was associated with improved clinical outcomes at 6 months.
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