What is the clinical evidence from this study?

Study design: Observational. Population: Severe functional mitral regurgitation (n=94). Intervention: Ischemic functional mitral regurgitation vs. Non-ischemic functional mitral regurgitation. Primary outcome: Maximum mitral annulus (MA) area (p=>0.05).

October 12, 2018Open Access

Comparison of mitral annulus geometry between patients with ischemic and non-ischemic functional mitral regurgitation: implications for transcatheter mitral valve implantation

PAPatrizia ArutaUniversity of Padua DMDenisa MuraruCardiac Imaging AGA C GutaHouston Methodist

Key Result

Ischemic and non-ischemic functional mitral regurgitation patients had similar maximum diastolic mitral annulus area (10.7 vs 11.6 cm2), but non-ischemic patients had larger mid-systolic dimensions.

Study Design

Type

Observational (n=94)

Multicenter

Structured PICO

Are there differences in mitral annulus geometry between patients with ischemic and non-ischemic severe functional mitral regurgitation assessed by 3D echocardiography?

Population

94 adult patients with severe functional mitral regurgitation (41 ischemic, 53 non-ischemic) underwent retrospective 3D echocardiographic analysis to compare mitral annulus geometry.

Outcome

Mitral annulus dimension and geometry parameters, left atrial and left ventricular volumes measured in early-diastole and mid-systolesurrogate

Ischemic and non-ischemic functional mitral regurgitation share similar maximum annulus dimensions but have systolic differences that may impact transcatheter mitral valve prosthesis selection.

Main Result

Absolute Event Rate: 10.7% vs 11.6%

p-value: p=>0.05

Limitations

Use of a new mitral valve software package that was not previously validated externally
Lack of comparison with multi-slice computed tomography (MSCT), the current gold standard for TMVR planning
Early-diastole had to be manually identified by the operator, increasing the possibility of errors
Retrospective study design

Abstract

BACKGROUND: Transcatheter mitral valve replacement (TMVR) is a new therapeutic option for high surgical risk patients with mitral regurgitation (MR). Mitral valve (MV) geometry quantification is of paramount importance for success of the procedure and transthoracic 3D echocardiography represents a useful screening tool. Accordingly, we sought to asses MV geometry in patients with functional MR (FMR) that would potentially benefit of TMVR, focusing on the comparison of mitral annulus (MA) geometry between patients with ischemic (IMR) and non ischemic mitral regurgitation (nIMR). METHODS: We retrospectively selected 94 patients with severe FMR: 41 (43,6%) with IMR and 53 (56,4%) with nIMR. 3D MA analysis was performed on dedicated transthoracic 3D data sets using a new, commercially-available software package in two moments of the cardiac cycle (early-diastole and mid-systole). We measured MA dimension and geometry parameters, left atrial and left ventricular volumes. RESULTS: , p > 0.05). CONCLUSIONS: Patients with ischemic and non-ischemic etiology of FMR have similar maximum dimension, yet systolic differences between the two groups should be taken into account to tailor prosthesis's selection. TRIAL REGISTRATION: N.A.

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