MitraClip therapy induced left ventricular reverse remodeling in 49% of patients at 12 months; severe residual MR (OR 0.26), male gender, and LVEF <20% predicted the absence of remodeling.
Cohort (n=164)
What are the predictors of left ventricular reverse remodeling after MitraClip implantation in patients with mitral regurgitation?
Left ventricular reverse remodeling occurs in about half of patients after MitraClip implantation and is associated with better clinical outcomes, but is less likely in males, those with LVEF <20%, or those with severe residual MR.
OBJECTIVES: To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR). BACKGROUND: MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited. METHODS: This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients. RESULTS: LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio OR = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361). CONCLUSIONS: LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.
Nita et al. (Thu,) conducted a cohort in Degenerative and functional mitral regurgitation (n=164). MitraClip therapy was evaluated on Left ventricular reverse remodeling (LVRR) at 12 months. MitraClip therapy induced left ventricular reverse remodeling in 49% of patients at 12 months; severe residual MR (OR 0.26), male gender, and LVEF <20% predicted the absence of remodeling.