TY - JOUR
T1 - Mitral regurgitation after percutaneous mitral valvuloplasty : insights into mechanisms and impact on clinical outcomes
AU - Nunes, Maria Carmo P.
AU - Levine, Robert A.
AU - Braulio, Renato
AU - Pascoal-Xavier, Marcelo A.
AU - Elmariah, Sammy
AU - Gomes, Nayana F. A.
AU - Soares, Juliana R.
AU - Esteves, William A. M.
AU - Zeng, Xin
AU - Dal-Bianco, Jacob P.
AU - Passos, Livia S. A.
AU - Passaglia, Luiz G.
AU - Ribeiro, Victor T.
AU - Gelape, Cláudio L.
AU - Costa, Paulo H. N.
AU - Lodi-Junqueira, Lucas
AU - Dutra, Walderez
AU - Tan, Timothy C.
AU - Aikawa, Elena
AU - Hung, Judy
PY - 2020
Y1 - 2020
N2 - Objectives: The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV). Background: Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis. Methods: Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR. Results: A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR. Conclusions: Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.
AB - Objectives: The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV). Background: Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis. Methods: Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR. Results: A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (Cn) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR. Conclusions: Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.
UR - https://hdl.handle.net/1959.7/uws:62601
U2 - 10.1016/j.jcmg.2020.07.020
DO - 10.1016/j.jcmg.2020.07.020
M3 - Article
SN - 1876-7591
VL - 13
SP - 2513
EP - 2526
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 12
ER -
