Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR)

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

doi:10.1016/j.ijcha.2019.100413

Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR)

Int J Cardiol Heart Vasc. 2019 Aug 30:24:100413. doi: 10.1016/j.ijcha.2019.100413. eCollection 2019 Sep.

Authors

Reinhard J Sauter^{1

2}, Johannes Patzelt^{1

2}, Matthias Mezger^{1

2}, Henry Nording^{1

2}, Jan-Christian Reil^{1

2}, Mohammed Saad^{1

2}, Peter Seizer³, Juergen Schreieck³, Peter Rosenberger⁴, Harald F Langer^{1

2}, Harry Magunia⁴

Affiliations

¹ University Hospital, Department of Cardiology, University Heart Center Luebeck, 23538 Luebeck, Germany.
² German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, 23538 Luebeck, Germany.
³ University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
⁴ University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.

Abstract

Introduction: In this study, we evaluated right ventricular (RV) function before and after percutaneous mitral valve repair (PMVR) using conventional echocardiographic parameters and novel 3DE data sets acquired prior to and directly after the procedure.

Patients and methods: Observational study on 45 patients undergoing PMVR at an university hospital.

Results: In the overall collective, the 3D RV-EF before and after PMVR showed no significant change (p = 0.16). While there was a significant increase of the fractional area change (FAC, from 23 [19-29] % to 28 [24-33] %, p = 0.001), no significant change of the tricuspid annular plane systolic excursion (TAPSE, from 17 ± 6 mm to 18 ± 5 mm (standard deviation), p = 0.33) was observed. Regarding patients with a reduced RV-EF (< 35%), a significant RV-EF improvement was observed (from 27 [23-34] % to 32.5 [30-39] % (p = 0.001). 71.4% of patients had an improved clinical outcome (improvement in 6-minute walk test and/or improvement in NYHA class of more than one grade), whereas clinical outcome did not improve in 28.6% of patients. Using univariate logistic regression analysis, the post-PMVR RV-EF (OR 1.15: 95% CI 1.02-1.29; p = 0.02) and the change in RV-EF (OR 1.13: 95% CI 1.02-1.25; p = 0.02) were significant predictors for improved clinical outcome at 6 months follow up.

Conclusion: Thus, RV function may be an important non-invasive parameter to add to the predictive parameters indicating a potential clinical benefit from treatment of severe mitral regurgitation using PMVR.

Keywords: 3D-echocardiography; 3DE, 3D-echocardiography; ACE, angiotensin converting enzyme; DMR, degenerative mitral regurgitation; EDV, end-diastolic volume; EF, ejection fraction; ESV, end-systolic volume; Echocardiography; FAC, fractional area change; FMR, functional mitral regurgitation; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; MR, mitral regurgitation; MRI, magnetic resonance imaging; Mitral regurgitation; NYHA, New York heart association functional classification; Outcome; PAMP, pulmonary artery mean pressure; PASP, pulmonary artery systolic pressure; PCWP, pulmonary capillary wedge pressure; PMVR, percutaneous mitral valve repair; Percutaneous mitral valve repair; RV function; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion; TAVR, transcatheter aortic valve replacement; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography.