Author + information
- Received August 7, 2018
- Revision received November 28, 2018
- Accepted December 4, 2018
- Published online March 18, 2019.
- Eleonora Avenatti, MDa,
- G. Burkhard Mackensen, MD, PhDb,
- Kinan Carlos El-Tallawi, MDa,
- Mark Reisman, MDc,
- Lara Gruye, MSb,
- Colin M. Barker, MDa and
- Stephen H. Little, MDa,∗ ()
- aDepartment of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
- bDivision of Cardiothoracic Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
- cDivision of Cardiology, University of Washington, Seattle, Washington
- ↵∗Address for correspondence:
Dr. Stephen H. Little, Department of Cardiology, Houston Methodist Hospital, 6550 Fannin Street, SM-677, Houston, Texas 77030.
Objectives The authors sought to define the feasibility and performance of 3-dimensional (3D) vena contracta area (VCA) measurement in evaluating total residual mitral regurgitation (MR) following percutaneous edge-to-edge clip (E-EC) mitral valve repair.
Background Residual MR severity after percutaneous repair is not only a determinant of procedural success, but also a major prognostic factor. To date, no single echocardiographic method has been recommended for post-procedural MR quantification, with the evaluation currently relying on a complex, multiparametric appraisal.
Method The authors performed a retrospective study of patients undergoing the E-EC procedure, for which baseline and post-repair 3D color Doppler transesophageal echocardiogram datasets were available. Total VCA was recorded as the sum of individual VCAs (if more than 1) and compared with an expert multiparametric appraisal of MR severity as the reference standard. Receiver-operating characteristic analysis was performed.
Results 155 patient studies were available for review. Total VCA correlated with hemodynamic parameters and was significantly reduced after E-EC. Receiver-operating characteristic analysis demonstrated a VCA threshold of 0.27 cm2 for identification of ≥moderate MR, with good diagnostic accuracy (area under the curve 0.81) and a negative predictive value of 92%. Smaller VCA was associated with clinical New York Heart Association functional class improvement at 30-day follow-up.
Conclusions Measurement of VCA is feasible using 3D color Doppler transesophageal echocardiography and provides reliable quantification of MR following E-EC transcatheter mitral valve repair.
- 3D echocardiography
- intraprocedural echocardiography
- mitral regurgitation
- transcatheter mitral repair
- vena contracta area
Dr. Avenatti was supported by the Dunn Foundation for Cardiovascular Research and Education, Houston, Texas. Dr. Barker has served on advisory boards for Medtronic and Boston Scientific. Dr. Little has received institutional research support from Abbott and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 7, 2018.
- Revision received November 28, 2018.
- Accepted December 4, 2018.
- 2019 American College of Cardiology Foundation
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