Pulmonary Vein Flow Morphology After Transcatheter Mitral Valve Edge-to-Edge Repair as Predictor of Survival - 02/05/24
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Abnormal post-MV-TEER PVF morphology is associated with higher LA pressure. |
• | Abnormal PVF is an independent marker of mortality after correction for residual MR. |
• | Consider the PVF pattern when optimizing MR reduction and medical therapy post-TEER. |
Keywords : Mitral regurgitation, Transcatheter edge-to-edge repair, Pulmonary vein flow
Abbreviations : HR, MR, MV, MV-TEER, PVF, TEE, TEER
Plan
Drs. El Shaer and Chavez Ponce contributed equally to this work. |
|
Robert J. Siegel, MD, served as guest editor for this report. |
Vol 37 - N° 5
P. 530-537 - mai 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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