Author + information
- Received June 18, 2018
- Revision received August 17, 2018
- Accepted September 25, 2018
- Published online January 21, 2019.
- Hiroki Ikenaga, MD,
- Jun Yoshida, MD,
- Atsushi Hayashi, MD,
- Takafumi Nagaura, MD,
- Satoshi Yamaguchi, MD,
- Florian Rader, MD,
- Robert J. Siegel, MD,
- Saibal Kar, MD and
- Takahiro Shiota, MD∗ ()
- ↵∗Address for correspondence:
Dr. Takahiro Shiota, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3411, Los Angeles, California 90048.
Objectives The aim of this study was to determine the prognostic value of pulmonary venous (PV) flow during MitraClip implantation.
Background The clinical significance of PV flow information during MitraClip implantation is unknown.
Methods A total of 300 patients who underwent MitraClip implantation and in whom the measurement of PV flow was completed using intraprocedural transesophageal echocardiography were retrospectively reviewed. The optimal threshold of the ratio of systolic velocity-time integral (Svti) to diastolic velocity-time integral (Dvti) ratio after MitraClip placement for major adverse cardiovascular events (all-cause death, redo MitraClip implantation, mitral valve surgery, and heart transplantation) during 12 months was assessed. The best cutoff ratio was 0.72. Patients were divided into 2 groups using this cutoff ratio (low Svti/Dvti, n = 91; high Svti/Dvti, n = 209).
Results Following mitral regurgitation reduction by MitraClip placement, Svti increased in the both groups. The frequency of mitral regurgitation 3/4+ immediately after MitraClip implantation, at 1-month follow-up, and at 12-month follow-up was significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (after MitraClip placement, 5.5% vs. 0%; p < 0.001; at 1 month; 26% vs. 5.2%; p < 0.001; at 12 months, 18% vs. 5.3%; p = 0.006). Major adverse cardiovascular events during 12 months were significantly higher in patients with low Svti/Dvti ratios than in those with high Svti/Dvti ratios (23% vs. 6.2%; p < 0.001). Multivariate analysis demonstrated that low Svti/Dvti ratio was significantly associated with major adverse cardiovascular events during 12 months after adjustment for age, baseline renal function, and mean transmitral pressure gradient (adjusted hazard ratio: 4.00; 95% confidence interval: 2.02 to 8.23; p < 0.001).
Conclusions PV flow information in the catheterization laboratory immediately after MitraClip implantation predicted recurrent mitral regurgitation and worse long-term outcomes.
Drs. Shiota and Siegel are speakers for Philips Ultrasound. Dr. Kar has received research grants and consulting fees from Abbott Vascular. Dr. Rader is a consultant of MyoKardia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 18, 2018.
- Revision received August 17, 2018.
- Accepted September 25, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.