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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Cardiovascular Ultrasound 1/2018

3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information

Zeitschrift:
Cardiovascular Ultrasound > Ausgabe 1/2018
Autoren:
Alexander Dietl, Christine Prieschenk, Franziska Eckert, Christoph Birner, Andreas Luchner, Lars S. Maier, Stefan Buchner
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12947-017-0120-9) contains supplementary material, which is available to authorized users.

Abstract

Background

Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D–transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV).

Methods

Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients’ functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D–colour-Doppler datasets were available before, during and 4 weeks after PMVR.

Results

Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9% NYHA III/IV) and severe degenerative (34%) or functional (66%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm2 vs. 0.22 ± 0.15 cm2, p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR.

Conclusions

VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients’ physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.
Zusatzmaterial
Additional file 1: Recommendation for intra−/post-procedural evaluation of MR (German Cardiac Society). (DOCX 28 kb)
12947_2017_120_MOESM1_ESM.docx
Additional file 2: Power calculation analysis revealed sufficient power. (DOCX 26 kb)
12947_2017_120_MOESM2_ESM.docx
Additional file 3: The subgroup of patients with follow-up TEE-examination 4 weeks after PMVR does not differ from the remaining study sample concerning sex, age or clinical manifestation of MR. (DOCX 23 kb)
12947_2017_120_MOESM3_ESM.docx
Additional file 4: Patients’ characteristics only differ in absolute decrease of VCA before/after PMVR between the two groups defined by median VCAr as a first hint for further insights (cf. text). (DOCX 28 kb)
12947_2017_120_MOESM4_ESM.docx
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