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Comprehensive echocardiographic prediction of postprocedural transmitral pressure gradient following transcatheter mitral valve repair

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Abstract

Iatrogenic mitral stenosis following transcatheter mitral valve repair (TMVR) for relevant mitral regurgitation (MR) is a potential adverse side-effect, known to affect long-term outcome. However, only few determinants of an elevated mean transmitral pressure gradient (TMPG) have been described thus far. We sought to develop an integrative model for the prediction of TMPG following MitraClip (MC) therapy. From 01/2013 to 03/2017, a total of 175 consecutive patients were successfully (MR ≤ 2 + at discharge) treated with a MitraClip implantation at our centre. Of these, a total of 148 patients (54% male, 77.0 ± 6.0 years, 58% with secondary MR) had complete echocardiographic data sets comprising pre- and postinterventional two- and three-dimensional transthoracic (TTE) and transoesophageal (TOE) echocardiograms. Comprehensive studies of predefined parameters were performed. An expert-based prediction model including preprocedural variables (annular ellipticity, mitral valve commissure-to-commissure diameter, preprocedural transmitral pressure gradient and MR aetiology) was set up and validated with a total of 200 bootstrap samples. A nomogram was developed to predict the postprocedural TMPG based on selected echocardiographic variables. Introduction of nomogram-based guiding of MC therapy could help identify patients at risk for postprocedural mitral stenosis, have an influence on preprocedural patient selection and intraprocedural decision making.

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Abbreviations

AI:

Aortic valve insufficiency

AS:

Aortic valve stenosis

BMI:

Body mass index

CRT:

Cardiac resynchronisation therapy

EF:

Ejection fraction

FMR:

Functional mitral valve regurgitation

FU:

Follow-up

HOCM:

Hypertrophic obstructive cardiomyopathy

LA:

Left atrial

LV:

Left ventricular

LVAD:

Left ventricular assist device

LVESD:

Left ventricular end-systolic diameter

LVEDD:

Left ventricular end-diastolic diameter

MC:

MitraClip

MI:

Myocardial infarction

MR:

Mitral regurgitation

MVA:

Mitral valve area

MVAE:

Mitral valve annular ellipticity

MVCCDIAM:

Mitral valve commissure-to-commissure diameter

MVOA:

Mitral valve orifice area

NT-proBNP:

N-terminal pro-brain natriuretic peptide

NYHA:

New York Heart Association

PH:

Pulmonary hypertension

PH-LHD:

Pulmonary hypertension due to left heart disease

PHT:

Pressure half-time

PMR:

Primary mitral regurgitation

SMR:

Secondary (functional) mitral valve regurgitation

sPAP:

Systolic pulmonary artery pressure

TMPG:

Transmitral mean pressure gradient

TMVR:

Transcatheter mitral valve repair

TR:

Tricuspid valve regurgitation

TOE:

Transoesophageal echocardiography

TTE:

Transthoracic echocardiography

3D:

Three-dimensional

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Authors and Affiliations

  1. Department of Cardiology and Intensive Care, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany

    Hannes Alessandrini, Peter Wohlmuth, Felix Meincke, Samer Hakmi, Timm Ubben, Sebastian Bohnen, Theresa Wißt, Stephan Willems & Eike Tigges

  2. LANS Medicum, Hamburg, Germany

    Karl-Heinz Kuck

Authors
  1. Hannes Alessandrini
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  2. Peter Wohlmuth
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  3. Felix Meincke
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  4. Samer Hakmi
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  5. Timm Ubben
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  6. Sebastian Bohnen
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  7. Theresa Wißt
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  8. Karl-Heinz Kuck
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  9. Stephan Willems
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  10. Eike Tigges
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Correspondence to Hannes Alessandrini.

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Karl-Heinz Kuck received research grants from Abbott Vascular Inc. The others autors report no conflict of interest.

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Alessandrini, H., Wohlmuth, P., Meincke, F. et al. Comprehensive echocardiographic prediction of postprocedural transmitral pressure gradient following transcatheter mitral valve repair. Int J Cardiovasc Imaging 37, 2947–2955 (2021). https://doi.org/10.1007/s10554-021-02290-4

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  • DOI: https://doi.org/10.1007/s10554-021-02290-4

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