Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival
Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes.
METHODS: Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated. Pulmonary vein flow patterns post-MV-TEER were reviewed on the procedural transesophageal echocardiogram and classified as normal (systolic dominant or codominant) or abnormal (systolic blunting or reversal). The PVF pattern was correlated with all-cause mortality at follow-up.
RESULTS: Two-hundred sixty-five patients had diagnostic PVF post-MV-TEER, with 73 (27.5%) categorized as normal and 192 (72.5%) categorized as abnormal. Patients with abnormal PVF morphology were more likely to have atrial fibrillation (70% vs 42%, P < .001) and greater than moderate residual MR (16% vs 3%, P = .01) and had higher mean left atrial pressure (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, P = .002) and left atrial V wave (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, P < .001) postprocedure. In multivariable analysis, abnormal PVF morphology post-MV-TEER was independently associated with mortality at follow-up (hazard ratio = 1.70; 95% CI, 1.06-2.74; P = .03) after correction for end-stage renal disease, atrial fibrillation, and residual MR. Results were similar in subgroups of patients with moderate or less and those with mild or less residual MR.
CONCLUSIONS: Pulmonary vein flow morphology is a simple and objective tool to assess MR severity immediately post-MV-TEER and offers important prognostic information to optimize procedural results. Additional studies are needed to determine whether patients with abnormal PVF pattern post-MV-TEER would benefit from more intensive goal-directed medical therapy postprocedure.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography - (2024) vom: 08. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
El Shaer, Ahmed [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Revised 14.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.echo.2024.01.016 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368305643 |
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| 100 | 1 | |a El Shaer, Ahmed |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival |
| 264 | 1 | |c 2024 | |
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| 520 | |a Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes | ||
| 520 | |a METHODS: Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated. Pulmonary vein flow patterns post-MV-TEER were reviewed on the procedural transesophageal echocardiogram and classified as normal (systolic dominant or codominant) or abnormal (systolic blunting or reversal). The PVF pattern was correlated with all-cause mortality at follow-up | ||
| 520 | |a RESULTS: Two-hundred sixty-five patients had diagnostic PVF post-MV-TEER, with 73 (27.5%) categorized as normal and 192 (72.5%) categorized as abnormal. Patients with abnormal PVF morphology were more likely to have atrial fibrillation (70% vs 42%, P < .001) and greater than moderate residual MR (16% vs 3%, P = .01) and had higher mean left atrial pressure (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, P = .002) and left atrial V wave (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, P < .001) postprocedure. In multivariable analysis, abnormal PVF morphology post-MV-TEER was independently associated with mortality at follow-up (hazard ratio = 1.70; 95% CI, 1.06-2.74; P = .03) after correction for end-stage renal disease, atrial fibrillation, and residual MR. Results were similar in subgroups of patients with moderate or less and those with mild or less residual MR | ||
| 520 | |a CONCLUSIONS: Pulmonary vein flow morphology is a simple and objective tool to assess MR severity immediately post-MV-TEER and offers important prognostic information to optimize procedural results. Additional studies are needed to determine whether patients with abnormal PVF pattern post-MV-TEER would benefit from more intensive goal-directed medical therapy postprocedure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Mitral regurgitation | |
| 650 | 4 | |a Pulmonary vein flow | |
| 650 | 4 | |a Transcatheter edge-to-edge repair | |
| 700 | 1 | |a Chavez Ponce, Alejandra A |e verfasserin |4 aut | |
| 700 | 1 | |a Ali, Mays T |e verfasserin |4 aut | |
| 700 | 1 | |a Oguz, Didem |e verfasserin |4 aut | |
| 700 | 1 | |a Pislaru, Sorin V |e verfasserin |4 aut | |
| 700 | 1 | |a Nkomo, Vuyisile T |e verfasserin |4 aut | |
| 700 | 1 | |a Padang, Ratnasari |e verfasserin |4 aut | |
| 700 | 1 | |a Eleid, Mackram F |e verfasserin |4 aut | |
| 700 | 1 | |a Guerrero, Mayra |e verfasserin |4 aut | |
| 700 | 1 | |a Reeder, Guy S |e verfasserin |4 aut | |
| 700 | 1 | |a Rihal, Charanjit S |e verfasserin |4 aut | |
| 700 | 1 | |a Alkhouli, Mohamad |e verfasserin |4 aut | |
| 700 | 1 | |a Thaden, Jeremy J |e verfasserin |4 aut | |
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