Author + information
- Received April 13, 2018
- Revision received July 16, 2018
- Accepted July 31, 2018
- Published online January 21, 2019.
- Shingo Kuwata, MD, PhDa,
- Maurizio Taramasso, MD, PhDa,
- Albert Czopak, MDa,
- Marco Luciani, MD, PhDa,
- Alberto Pozzoli, MDa,
- Edwin Ho, MDa,
- Adolfo Ferrero Guadagnoli, MDa,
- Matteo Saccocci, MDa,
- Oliver Gaemperli, MDa,
- Fabian Nietlispach, MD, PhDa,
- Michel Zuber, MDa,
- Ted Feldman, MDb and
- Francesco Maisano, MDa,∗ ()
- aUniversity Heart Center Zürich, University Hospital of Zurich, Zurich, Switzerland
- bDepartment of Medicine, Division of Cardiology, North Shore University Health System, Evanston Hospital, Evanston, Illinois
- ↵∗Address for correspondence:
Dr. Francesco Maisano, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland.
Objectives The aim of this study was to assess the additional utility of measuring left atrial (LA) pressure as a complement to transesophageal echocardiography (TEE) and Doppler imaging.
Background The efficacy of the MitraClip (MC) is assessed intraoperatively by TEE. However, TEE measures are operator dependent and can be influenced by left ventricular (LV) function and changes in LA compliance.
Methods Fifty patients undergoing MC therapy with continuous left-sided heart pressure measurements were analyzed. LA V-wave pressure (LAvP), LA mean pressure (LAmP), LV systolic pressure, and LV end-diastolic pressure were measured continuously. LA pressures were indexed to LV pressures to account for changes in afterload during the procedure.
Results Most patients (70%) had degenerative mitral regurgitation (MR). TEE MR grade decreased from 3+ to 0+. LAvP (p < 0.001), LAmP (p = 0.007), LV end-diastolic pressure (p = 0.001), LAvP index (p < 0.001), and LAmP index (p = 0.001) decreased significantly, and LV systolic pressure(p = 0.009) significantly increased after MC therapy. In multivariate Cox regression analysis, intraprocedural increase of LAmP index, but not post-MC ≥2+ residual MR, was significantly associated with rehospitalization due to heart failure (hazard ratio: 3.377; 95% CI: 3.180 to 3.585; p = 0.007) and with New York Heart Association functional class III to IV (hazard ratio: 1.497; 95% CI: 1.006 to 2.102; p = 0.005) in the follow-up period.
Conclusions This study demonstrates the value of real-time monitoring of LA pressure during MC therapy to predict clinical outcomes. An increase in LAmP was a predictive of worse clinical outcomes at short-term follow-up, independent from echocardiographic findings.
Dr. Taramasso has served as a consultant for Abbott Vascular. Dr. Nietlispach has served as a consultant for Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Feldman has served as a consultant for and has received research grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Gore Medical. Dr. Maisano has served as a consultant for and received research grant support from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2018.
- Revision received July 16, 2018.
- Accepted July 31, 2018.
- 2019 American College of Cardiology Foundation
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