Cardiovascular Ultrasound (Dec 2019)

Transcatheter MitraClip repair alters mitral annular geometry – device induced annular remodeling on three-dimensional echocardiography predicts therapeutic response

  • Jiwon Kim,
  • Maria Chiara Palumbo,
  • Omar K. Khalique,
  • Lisa Q. Rong,
  • Razia Sultana,
  • Mukund Das,
  • Jennifer Jantz,
  • Yasfumi Nagata,
  • Richard B. Devereux,
  • Shing Chiu Wong,
  • Geoffrey W. Bergman,
  • Robert A. Levine,
  • Mark B. Ratcliffe,
  • Jonathan W. Weinsaft

DOI
https://doi.org/10.1186/s12947-019-0181-z
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 11

Abstract

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Abstract Background Echocardiography (echo) is widely used to guide therapeutic decision-making for patients being considered for MitraClip. Relative utility of two- (2D) and three-dimensional (3D) echo predictors of MitraClip response, and impact of MitraClip on mitral annular geometry, are uncertain. Methods The study population comprised patients with advanced (> moderate) MR undergoing MitraClip. Mitral annular geometry was quantified on pre-procedural 2D transthoracic echocardiography (TTE) and intra-procedural 3D transesophageal echocardiography (TEE); 3D TEE was used to measure MitraClip induced changes in annular geometry. Optimal MitraClip response was defined as ≤mild MR on follow-up (mean 2.7 ± 2.5 months) post-procedure TTE. Results Eighty patients with advanced MR underwent MitraClip; 41% had optimal response (≤mild MR). Responders had smaller pre-procedural global left ventricular (LV) end-diastolic size and mitral annular diameter on 2D TTE (both p ≤ 0.01), paralleling smaller annular area and circumference on 3D TEE (both p = 0.001). Mitral annular size yielded good diagnostic performance for optimal MitraClip response (AUC 0.72, p mild MR) on followup TTE (p = 0.017); greater magnitude of device-induced annular reduction remained associated with sub-optimal MitraClip response even when normalized for pre-procedure annular circumference (p = 0.028). Conclusions MitraClip alters mitral annular geometry as quantified by intra-procedural 3D TEE. Pre-procedural mitral annular dilation and magnitude of device-induced reduction in mitral annular size on 3D TEE are each associated with sub-optimal therapeutic response to MitraClip.

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