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Distinct Hemodynamic Changes After Interventional Mitral Valve Edge-to-Edge Repair in Different Phenotypes of Heart Failure: An Integrated Hemodynamic Analysis
- Source :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
- Publication Year :
- 2018
-
Abstract
- Background Percutaneous mitral valve edge‐to‐edge repair ( pMVR ) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction ( EF ). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure‐volume loops to investigate the left ventricular (LV) remodeling of patients after pMVR dependent on their baseline EF. Methods and Results In 130 patients with successful pMVR , the end‐diastolic pressure‐volume relationship (EDPVR) and end‐systolic pressure‐volume relationship were estimated noninvasively from echocardiographic data. We compared EDPVR and end‐systolic pressure‐volume relationship at discharge and follow‐up between patients with a reduced EF (EF (≥40%). Reduced EF was present in 71 patients (54%). Mean follow‐up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow‐up irrespective of baseline EF . In patients with a mid‐ranged or preserved EF , the EDPVR and end‐systolic pressure‐volume relationship were shifted leftwards, suggesting an improvement in LV function. In contrast, in patients with a reduced EF , EDPVR and end‐systolic pressure‐volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the EDPVR . This indicates that there is no improvement in LV function after pMVR in patients with reduced EF. Conclusions The pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid‐ranged or preserved EF , we found reverse remodeling with reduced LV dilatation and increased contractility. In contrast, in patients with reduced EF , we observed no reverse remodeling and no improvement in LV function.
- Subjects :
- Male
Time Factors
Hemodynamics
030204 cardiovascular system & hematology
hemodynamics
Ventricular Function, Left
0302 clinical medicine
Catheter-Based Coronary and Valvular Interventions
Mitral valve
pressure‐volume relationship
030212 general & internal medicine
Registries
Original Research
Aged, 80 and over
Ejection fraction
Ventricular Remodeling
MitraClip
Mitral Valve Insufficiency
Remodeling
medicine.anatomical_structure
Phenotype
Treatment Outcome
Cardiology
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
Percutaneous Mitral Valve Repair
medicine.medical_specialty
03 medical and health sciences
Internal medicine
medicine
Ventricular Pressure
Humans
percutaneous mitral valve repair
Cardiac Surgical Procedures
Ventricular remodeling
Aged
Retrospective Studies
Echocardiography, Doppler, Pulsed
Heart Failure
Mitral regurgitation
business.industry
Stroke Volume
Recovery of Function
medicine.disease
Myocardial Contraction
Heart failure
Valvular Heart Disease
mitral regurgitation
business
Subjects
Details
- ISSN :
- 20479980
- Volume :
- 7
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of the American Heart Association
- Accession number :
- edsair.doi.dedup.....d8e99ffe6955fb128e862e5e75500c78