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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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3D Echo Characterization of Proportionate and Disproportionate Functional Mitral Regurgitation before and after

Sara Cimino1, Luciano Agati1, Domenico Filomena1

  • 1Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy.

Journal of Clinical Medicine
|February 15, 2022
PubMed
Abstract

Insights

Patients with proportionate mitral regurgitation (P-MR) face worse outcomes after percutaneous mitral valve repair (PMVr) compared to disproportionate mitral regurgitation (D-MR) patients. The effective regurgitant orifice area/left ventricular end-diastolic volume (EROA/LVEDV) ratio is crucial for stratifying functional mitral regurgitation (FMR) risk.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Long-term prognosis after percutaneous mitral valve repair (PMVr) for functional mitral regurgitation (FMR) remains uncertain.
  • A new classification divides FMR into proportionate (P-MR) and disproportionate (D-MR) based on the EROA/LVEDV ratio.
  • This study investigates the influence of this classification on PMVr efficacy.

Purpose of the Study:

  • To evaluate the impact of the P-MR/D-MR classification on the outcomes of PMVr.
  • To assess the prognostic value of the EROA/LVEDV ratio in FMR patients undergoing PMVr.

Main Methods:

  • Fifty-six patients with FMR undergoing PMVr were analyzed.
  • Patients were categorized into P-MR and D-MR groups based on the EROA/LVEDV ratio.
  • Echocardiographic parameters (including GLS) and clinical adverse events (CV death, HF rehospitalization) were assessed at 6 and 12 months.

Main Results:

  • D-MR patients exhibited distinct anatomical characteristics, including a more elliptical mitral valve annulus and preserved LV ejection fraction.
  • P-MR patients demonstrated a higher rate of MR recurrence at 6 months.
  • At 12 months, P-MR patients had significantly higher rates of cardiovascular death and heart failure rehospitalization (46% vs. 7%).

Conclusions:

  • Patients with P-MR experience significantly worse clinical outcomes following PMVr compared to D-MR patients.
  • The EROA/LVEDV ratio effectively stratifies FMR patients into prognostically distinct subgroups.
  • This classification aids in understanding mitral valve and left ventricular anatomical differences influencing PMVr success.
Keywords:
EROA/LVEDV ratioMitraClipPMVrdisproportionate MRfunctional mitral regurgitation

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