Johannes Patzelt1, Yingying Zhang2, Harry Magunia3, Rezo Jorbenadze1, Michal Droppa1, Miriam Ulrich1, Shanglang Cai4, Henning Lausberg5, Tobias Walker5, Tobias Wengenmayer6, Peter Rosenberger3, Juergen Schreieck1, Peter Seizer1, Meinrad Gawaz1, Harald F Langer7. 1. University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. 2. University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China. 3. University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. 4. University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China. 5. University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. 6. Department of Cardiology and Angiology, Heart Center Freiburg University, 79106 Freiburg im Breisgau, Germany. 7. University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. Electronic address: harald.langer@med.uni-tuebingen.de.
Abstract
BACKGROUND: Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS: 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). RESULTS: All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. CONCLUSIONS: CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
BACKGROUND: Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. METHODS: 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). RESULTS: All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. CONCLUSIONS: CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
Authors: Johannes Patzelt; Miriam Ulrich; Harry Magunia; Reinhard Sauter; Michal Droppa; Rezo Jorbenadze; Annika S Becker; Tobias Walker; Ralph Stephan von Bardeleben; Christian Grasshoff; Peter Rosenberger; Meinrad Gawaz; Peter Seizer; Harald F Langer Journal: J Am Heart Assoc Date: 2017-12-02 Impact factor: 5.501
Authors: Ester Herrmann; Andreas Ecke; Eva Herrmann; Nina Eissing; Stephan Fichtlscherer; Andreas M Zeiher; Birgit Assmus Journal: ESC Heart Fail Date: 2018-06-12
Authors: Johannes Patzelt; Miriam Ulrich; Annika Becker; Karin A L Müller; Rezo Jorbenadze; Michal Droppa; Wenzhong Zhang; Sarah Mandel; Lisa Habel; Henning Lausberg; Janine Pöss; Tobias Geisler; Oliver Borst; Peter Rosenberger; Christian Schlensak; Meinrad Gawaz; Jürgen Schreieck; Peter Seizer; Harald F Langer Journal: PLoS One Date: 2018-10-19 Impact factor: 3.240
Authors: Reinhard J Sauter; Johannes Patzelt; Matthias Mezger; Henry Nording; Jan-Christian Reil; Mohammed Saad; Peter Seizer; Juergen Schreieck; Peter Rosenberger; Harald F Langer; Harry Magunia Journal: Int J Cardiol Heart Vasc Date: 2019-08-30
Authors: Hou Bo; David Heinzmann; Christian Grasshoff; Peter Rosenberger; Christian Schlensak; Meinrad Gawaz; Jürgen Schreieck; Harald F Langer; Johannes Patzelt; Peter Seizer Journal: Clin Cardiol Date: 2019-09-09 Impact factor: 2.882