In 130 patients, percutaneous mitral valve edge-to-edge repair led to reverse LV remodeling in those with mid-ranged/preserved EF, but not in the 71 patients (54%) with reduced EF.
Cohort (n=130)
Does percutaneous mitral valve edge-to-edge repair result in different left ventricular remodeling responses in patients with reduced versus mid-ranged/preserved ejection fraction?
Percutaneous mitral valve edge-to-edge repair improves clinical symptoms across all EF phenotypes, but induces reverse LV remodeling only in patients with mid-ranged or preserved EF, not in those with reduced EF.
BACKGROUND: Percutaneous mitral valve edge-to-edge repair (pMVR) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction (EF). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure-volume loops to investigate the left ventricular (LV) remodeling of patients after pMVR dependent on their baseline EF. METHODS AND RESULTS: In 130 patients with successful pMVR, the end-diastolic pressure-volume relationship (EDPVR) and end-systolic pressure-volume relationship were estimated noninvasively from echocardiographic data. We compared EDPVR and end-systolic pressure-volume relationship at discharge and follow-up between patients with a reduced EF (<40%) and patients with a mid-ranged or preserved EF (≥40%). Reduced EF was present in 71 patients (54%). Mean follow-up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow-up irrespective of baseline EF. In patients with a mid-ranged or preserved EF, the EDPVR and end-systolic pressure-volume relationship were shifted leftwards, suggesting an improvement in LV function. In contrast, in patients with a reduced EF, EDPVR and end-systolic pressure-volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the EDPVR. This indicates that there is no improvement in LV function after pMVR in patients with reduced EF. CONCLUSIONS: The pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid-ranged or preserved EF, we found reverse remodeling with reduced LV dilatation and increased contractility. In contrast, in patients with reduced EF, we observed no reverse remodeling and no improvement in LV function.
Schrage et al. (Thu,) conducted a cohort in Heart failure (n=130). Percutaneous mitral valve edge-to-edge repair (pMVR) vs. Comparison between reduced EF (<40%) and mid-ranged/preserved EF (≥40%) was evaluated on Left ventricular remodeling (end-diastolic and end-systolic pressure-volume relationships). In 130 patients, percutaneous mitral valve edge-to-edge repair led to reverse LV remodeling in those with mid-ranged/preserved EF, but not in the 71 patients (54%) with reduced EF.