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Usefulness of computed tomography to predict residual mitral regurgitation after transcatheter mitral valve edge-to-edge repair

Published:August 10, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.07.017

      Highlights

      • Residual mitral regurgitation (MR) after MitraClip impacts long-term outcomes
      • Computed tomography is useful to predict residual MR
      • Mitral valve orifice area/mitral annulus area (MVOA/MAA) ratio and leaflet calcium were predictors of residual MR
      • MVOA/MAA <0.31 and leaflet calcium increased risk of mitral reintervention at 1 year

      Abstract

      Background

      Multidetector computed tomography (MDCT) can provide valuable information for preprocedural planning of transcatheter mitral valve interventions. However, no data exist on MDCT parameters predicting residual mitral regurgitation (MR) post-MitraClip (Abbott Laboratories, Abbott Park, IL, USA).

      Methods

      We analyzed preprocedural MDCTs of 78 consecutive patients with secondary MR undergoing MitraClip implantation at our institution. Moderate-or-severe mitral leaflet calcification (MLC) was defined as calcification, with-or-without mitral annular calcification, extending beyond the mitral leaflet base. Residual MR was assessed by postprocedural transesophageal echocardiography, and clinical outcomes were assessed at 1-year.

      Results

      Fifteen patients (19 %) had residual MR ≥2+. Compared to patients with none-or-mild residual MR, MDCT-derived mitral valve orifice area (MVOA) to mitral annulus area (MAA) ratio was significantly lower (0.32 ± 0.06 vs. 0.39 ± 0.09; p = 0.003), and the prevalence of MLC was higher (40 % vs. 18 %; p = 0.057) in those with residual MR ≥2+. Furthermore, the MVOA/MAA ratio and MLC were independent predictors of residual MR ≥2+ post-MitraClip [adjusted odds ratio (ORadj): 0.88 (0.80–0.97) and 5.50 (1.16–26.23), respectively]. On receiver-operating-characteristic-curve analysis, MVOA/MAA ratio <0.31 had a sensitivity of 87 % and a specificity of 60 % for residual MR ≥2+. When patients were classified according to the presence of MLC and an MVOA/MAA ratio <0.31, those with both parameters had significantly higher rates of postprocedural residual MR ≥2+ and mitral reintervention at 1-year than those with only one, and those without both parameters.

      Conclusions

      In patients with secondary MR undergoing the MitraClip procedure, preprocedural MDCT parameters, specifically MVOA/MAA ratio and MLC, are useful to predict postprocedural residual MR.

      Graphical abstract

      Keywords

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      References

        • Bonow R.O.
        • O'Gara P.T.
        • Adams D.H.
        • Badhwar V.
        • Bavaria J.E.
        • Elmariah S.
        • et al.
        2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the american College of Cardiology Solution set Oversight Committee.
        J Am Coll Cardiol. 2020; 75: 2236-2270
        • Writing Committee Members
        • Otto C.M.
        • Nishimura R.A.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin III, J.P.
        2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2021; 77 (e25-197)
        • Reichart D.
        • Kalbacher D.
        • Rubsamen N.
        • Tigges E.
        • Thomas C.
        • Schirmer J.
        • et al.
        The impact of residual mitral regurgitation after MitraClip therapy in functional mitral regurgitation.
        Eur J Heart Fail. 2020; 22: 1840-1848
        • Feldman T.
        • Foster E.
        • Glower D.D.
        • Kar S.
        • Rinaldi M.J.
        • Fail P.S.
        • et al.
        Percutaneous repair or surgery for mitral regurgitation.
        N Engl J Med. 2011; 364: 1395-1406
        • Stone G.W.
        • Lindenfeld J.
        • Abraham W.T.
        • Kar S.
        • Lim D.S.
        • Mishell J.M.
        • et al.
        Transcatheter mitral-valve repair in patients with heart failure.
        N Engl J Med. 2018; 379: 2307-2318
        • Tabata N.
        • Weber M.
        • Sugiura A.
        • Ozturk C.
        • Ishii M.
        • Tsujita K.
        • et al.
        Impact of the leaflet-to-annulus index on residual mitral regurgitation in patients undergoing edge-to-edge mitral repair.
        JACC Cardiovasc Interv. 2019; 12: 2462-2472
        • Hirasawa K.
        • Namazi F.
        • Milhorini Pio S.
        • Vo N.M.
        • Ajmone Marsan N.
        • Bax J.J.
        • et al.
        Insufficient mitral leaflet remodeling in relation to annular dilation and risk of residual mitral regurgitation after MitraClip implantation.
        JACC Cardiovasc Imaging. 2021; 14: 756-765
        • Blanke P.
        • Dvir D.
        • Cheung A.
        • Levine R.A.
        • Thompson C.
        • Webb J.G.
        • et al.
        Mitral annular evaluation with CT in the context of transcatheter mitral valve replacement.
        JACC Cardiovasc Imaging. 2015; 8: 612-615
        • Yoon S.H.
        • Bleiziffer S.
        • Latib A.
        • Eschenbach L.
        • Ancona M.
        • Vincent F.
        • et al.
        Predictors of left ventricular outflow tract obstruction after transcatheter mitral valve replacement.
        JACC Cardiovasc Interv. 2019; 12: 182-193
        • Zoghbi W.A.
        • Adams D.
        • Bonow R.O.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • et al.
        Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.
        J Am Soc Echocardiogr. 2017; 30: 303-371
        • Bloodworth CHt
        • Pierce E.L.
        • Kohli K.
        • Deaton N.J.
        • Jones K.J.
        • Duvvuri R.
        Impact of simulated MitraClip on forward flow obstruction in the setting of mitral leaflet tethering: an in vitro investigation.
        Catheter Cardiovasc Interv. 2018; 92: 797-807
        • Magne J.
        • Pibarot P.
        • Dagenais F.
        • Hachicha Z.
        • Dumesnil J.G.
        • Senechal M.
        Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation.
        Circulation. 2007; 115: 782-791
        • Eleid M.F.
        • Foley T.A.
        • Said S.M.
        • Pislaru S.V.
        • Rihal C.S.
        Severe mitral annular calcification: multimodality imaging for therapeutic strategies and interventions.
        JACC Cardiovasc Imaging. 2016; 9: 1318-1337
        • Mahnken A.H.
        • Muhlenbruch G.
        • Das M.
        • Wildberger J.E.
        • Kuhl H.P.
        • Gunther R.W.
        • et al.
        MDCT detection of mitral valve calcification: prevalence and clinical relevance compared with echocardiography.
        AJR Am J Roentgenol. 2007; 188: 1264-1269
        • Murphy D.J.
        • Ge Y.
        • Don C.W.
        • Keraliya A.
        • Aghayev A.
        • Morgan R.
        • et al.
        Use of cardiac computerized tomography to predict neo-left ventricular outflow tract obstruction before transcatheter mitral valve replacement.
        J Am Heart Assoc. 2017; 6e007353
        • Yoon S.H.
        • Whisenant B.K.
        • Bleiziffer S.
        • Delgado V.
        • Dhoble A.
        • Schofer N.
        • et al.
        Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification.
        Eur Heart J. 2019; 40: 441-451
        • Obadia J.F.
        • Messika-Zeitoun D.
        • Leurent G.
        • Iung B.
        • Bonnet G.
        • Piriou N.
        • et al.
        Percutaneous repair or medical treatment for secondary mitral regurgitation.
        N Engl J Med. 2018; 379: 2297-2306
        • Grayburn P.A.
        New concepts in functional mitral regurgitation: it is not just a disease of the left ventricle.
        J Am Coll Cardiol. 2013; 61: 1817-1819
        • Grande-Allen K.J.
        • Borowski A.G.
        • Troughton R.W.
        • Houghtaling P.L.
        • Dipaola N.R.
        • Moravec C.S.
        • et al.
        Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements: an extracellular matrix and echocardiographic study.
        J Am Coll Cardiol. 2005; 45: 54-61
        • Puri R.
        • Dundon B.K.
        • Khurana S.
        • Worthley M.I.
        • Edwards J.
        • Worthley S.G.
        Gross echocardiographic underestimation of mitral valve calcification–a near fatal experience.
        Int J Cardiol. 2010; 143 (e24-6)