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Quantification of mitral regurgitation during percutaneous mitral valve repair: added value of simultaneous hemodynamic and 3D echocardiographic assessment

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Abstract

The objective of this study was to investigate the usefulness of intraprocedural hemodynamic monitoring for MR evaluation during pMRV. Assessment of mitral regurgitation (MR) during percutaneous mitral valve repair (pMVR) procedure is challenging. 3D color Doppler allows exact quantification of MR, but is technically demanding. Sixty patients with moderate to severe MR (14 with structural and 46 functional MR) were included in the study. Intraprocedural pressure curves were continuously obtained in the left atrium (LA) and left ventricle (LV). Transesophageal echocardiography was performed using 3D color Doppler derived mean vena contracta area (VCAmean) and mitral regurgitation volume (RegVol) to quantify MR severity before and after each clip implantation. In the entire patient group, strongest correlations were observed firstly between VCA and the raise of the ascending limb of the left atrial V pressure wave (Vascend; r = 0.58, p < 0.001) and secondly between the difference of peak V wave pressure and mean LA pressure divided by systolic LV pressure [(Vpeak − LAmean) − LVsystole; r = 0.53, p < 0.001]. In patients with structural MR, the highest area under the ROC curve for prediction of mild MR (VCAmean < 0.2 cm² and RegVol < 30 ml) after clip implantation was found for Vascend (AUC 0.89, p < 0.001) whereas in functional MR calculation of (Vpeak − LAmean) − LVsystole showed the highest predictive value (AUC 0.69, p = 0.003). Invasive pressure monitoring can give a direct feedback with regard to the success of clip placement during pMVR.

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Abbreviations

BMI:

Body mass index

DMR:

Degenerative mitral regurgitation

FMR:

Functional mitral regurgitation

LA:

Left atrium

LAcomp :

LA compliance

LAmean :

Mean LA pressure

LV:

Left ventricle

LVarea :

Area under the pressure–time curve derived from the LV

LVEDP:

Left ventricular end diastolic pressure

LVsystole :

Peak systolic left ventricular pressure

MR:

Mitral regurgitation

RegVol:

Regurgitation volume measured by VCA method

RRdiastolic:

Diastolic blood pressure

RRsystolic:

Systolic blood pressure

VCA:

Vena contracta area derived by 3D color Doppler echocardiography

Vpeak :

Peak pressure value of the left atrial V wave

Varea :

Area under the pressure–time curve of the left atrial V wave

Vascend :

Velocity of pressure rise of the left atrial V wave

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Acknowledgements

Björn Goebel and Ali Hamadanchi have received a travel grant by Abbott Vascular to attend EuroEcho-Imaging congress 2015. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

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Authors and Affiliations

  1. Divisions of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine 1, Friedrich-Schiller-University of Jena, Erlanger Allee 101, 07740, Jena, Germany

    Ilonka Rohm, Tudor C. Poerner, Ali Hamadanchi, Sylvia Otto, P. Christian Schulze & Björn Goebel

  2. Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, Erlanger Allee 101, 07747, Jena, Germany

    Torsten Doenst

  3. Department of Medicine, Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Christian Jung

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  1. Ilonka Rohm
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  2. Tudor C. Poerner
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  3. Ali Hamadanchi
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  4. Sylvia Otto
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  8. Björn Goebel
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Correspondence to Ilonka Rohm.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Ilonka Rohm and Tudor C. Poerner contributed equally to this work.

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Rohm, I., Poerner, T.C., Hamadanchi, A. et al. Quantification of mitral regurgitation during percutaneous mitral valve repair: added value of simultaneous hemodynamic and 3D echocardiographic assessment. Int J Cardiovasc Imaging 33, 1531–1539 (2017). https://doi.org/10.1007/s10554-017-1153-8

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  • DOI: https://doi.org/10.1007/s10554-017-1153-8

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