Juliëtte F Velu1, Alexander Hirsch2, S M Boekholdt1, Karel T Koch1, M Marije Vis1, R Nils Planken3, Jan J Piek1, Jan Baan1, Berto J Bouma1. 1. Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 3. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Abstract
BACKGROUND: High-risk patients with mitral regurgitation (MR) may be treated by a percutaneous mitral valve repair with the MitraClip, but identification of patients who may benefit remains difficult. We aimed to determine whether myocardial fibrosis predicts outcome in MR patients undergoing MitraClip implantation and is beneficial in clinical decision making. METHODS: Preprocedural to the MitraClip implantation, myocardial fibrosis was analyzed with cardiovascular magnetic resonance (CMR) through late gadolinium enhancement. The CMR data were core-lab adjudicated measured before the MitraClip implantation. Adverse outcome was defined as New York Heart Association (NYHA) class III or IV after 1 month or death within 1 month after the MitraClip implantation. RESULTS: In total, 23 patients underwent preprocedural CMR, mean age 80 ± 9 years, 45% male, 64% atrial fibrillation and 73% NYHA class III or IV at baseline. Myocardial fibrosis was present in 55% of the patients with degenerative MR and in 64% of the patients with functional MR. An adverse outcome occurred in 69% of the patients with myocardial fibrosis and in 11% of the patients without myocardial fibrosis (P = 0.01). CONCLUSIONS: Our hypothesis-generating study showed that the presence of myocardial fibrosis predicts adverse outcome in patients undergoing MitraClip implantation. After confirmation with larger sample size, identification of myocardial fibrosis might contribute to assess prognosis and to clinical decision making.
BACKGROUND: High-risk patients with mitral regurgitation (MR) may be treated by a percutaneous mitral valve repair with the MitraClip, but identification of patients who may benefit remains difficult. We aimed to determine whether myocardial fibrosis predicts outcome in MRpatients undergoing MitraClip implantation and is beneficial in clinical decision making. METHODS: Preprocedural to the MitraClip implantation, myocardial fibrosis was analyzed with cardiovascular magnetic resonance (CMR) through late gadolinium enhancement. The CMR data were core-lab adjudicated measured before the MitraClip implantation. Adverse outcome was defined as New York Heart Association (NYHA) class III or IV after 1 month or death within 1 month after the MitraClip implantation. RESULTS: In total, 23 patients underwent preprocedural CMR, mean age 80 ± 9 years, 45% male, 64% atrial fibrillation and 73% NYHA class III or IV at baseline. Myocardial fibrosis was present in 55% of the patients with degenerative MR and in 64% of the patients with functional MR. An adverse outcome occurred in 69% of the patients with myocardial fibrosis and in 11% of the patients without myocardial fibrosis (P = 0.01). CONCLUSIONS: Our hypothesis-generating study showed that the presence of myocardial fibrosis predicts adverse outcome in patients undergoing MitraClip implantation. After confirmation with larger sample size, identification of myocardial fibrosis might contribute to assess prognosis and to clinical decision making.
Authors: Estibaliz Castillero; Daniel P Howsmon; Bruno V Rego; Samuel J Keeney; Kathryn H Driesbaugh; Takayuki Kawashima; Yingfei Xue (薛应騛); Chiara Camillo; Isaac George; Robert C Gorman; Joseph H Gorman; Michael S Sacks; Robert J Levy; Giovanni Ferrari Journal: Arterioscler Thromb Vasc Biol Date: 2021-04-08 Impact factor: 10.514
Authors: Rodrigo Estévez-Loureiro; Marta Tavares Da Silva; José Antonio Baz-Alonso; Berenice Caneiro-Queija; Manuel Barreiro-Pérez; Francisco Calvo-Iglesias; Rocio González-Ferreiro; Luis Puga; Miguel Piñón; Andrés Íñiguez-Romo Journal: Front Cardiovasc Med Date: 2022-09-23