Acute Changes in Left Atrial Pressure after MitraClip Are Associated with Improvement in 6-Minute Walk Distance

Elad Maor, Claire E. Raphael, Sidakpal S. Panaich, Guy S. Reeder, Rick A. Nishimura, Vuyisile T Nkomo, Charanjit Rihal, Mackram Eleid

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background - Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT). Methods and Results - Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234-394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1-6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6-19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19-47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (P=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (P=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (P=0.05). Conclusions - Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.

Original languageEnglish (US)
Article numbere004856
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2017

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Atrial Pressure
Walk Test
Mitral Valve Insufficiency
Population
Hemodynamics
Exercise

Keywords

  • atrial pressure
  • echocardiography
  • exercise
  • mitral valve
  • walk test

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Acute Changes in Left Atrial Pressure after MitraClip Are Associated with Improvement in 6-Minute Walk Distance. / Maor, Elad; Raphael, Claire E.; Panaich, Sidakpal S.; Reeder, Guy S.; Nishimura, Rick A.; Nkomo, Vuyisile T; Rihal, Charanjit; Eleid, Mackram.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 4, e004856, 01.04.2017.

Research output: Contribution to journalArticle

Maor, Elad ; Raphael, Claire E. ; Panaich, Sidakpal S. ; Reeder, Guy S. ; Nishimura, Rick A. ; Nkomo, Vuyisile T ; Rihal, Charanjit ; Eleid, Mackram. / Acute Changes in Left Atrial Pressure after MitraClip Are Associated with Improvement in 6-Minute Walk Distance. In: Circulation: Cardiovascular Interventions. 2017 ; Vol. 10, No. 4.
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abstract = "Background - Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT). Methods and Results - Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68{\%}) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234-394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1-6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6-19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19-47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (P=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49{\%} increased likelihood for improvement in 6-minute walk (P=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (P=0.05). Conclusions - Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.",
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T1 - Acute Changes in Left Atrial Pressure after MitraClip Are Associated with Improvement in 6-Minute Walk Distance

AU - Maor, Elad

AU - Raphael, Claire E.

AU - Panaich, Sidakpal S.

AU - Reeder, Guy S.

AU - Nishimura, Rick A.

AU - Nkomo, Vuyisile T

AU - Rihal, Charanjit

AU - Eleid, Mackram

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N2 - Background - Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT). Methods and Results - Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234-394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1-6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6-19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19-47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (P=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (P=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (P=0.05). Conclusions - Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.

AB - Background - Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pressure after MitraClip and improvement in exercise capacity as documented by 6-minute walk test (6MWT). Methods and Results - Study population included 50 patients who underwent MitraClip at the Mayo Clinic (Rochester, MN), between June 2014 and July 2016 and completed both baseline and 30-day follow-up 6MWT. Primary outcome for the current analysis was defined as 6MWT improvement above the median. Mean age of the study population was 79±10 years, and 34 (68%) were men. Baseline preprocedural 6MWT distance was 308 m (interquartile range [IQR], 234-394 m). Acute, intraprocedural change in LA pressure after MitraClip was 3 mm Hg (IQR, 1-6 mm Hg), and change in V wave was 11 mm Hg (IQR, 6-19 mm Hg). Median 6MWT improvement was 25 m (IQR, 19-47 m). Univariate analysis showed that patients with ≤ mild postprocedural mitral regurgitation were 4-fold more likely to experience an improvement in 6MWT (P=0.02). Multivariate model demonstrated that each 5 mm Hg decrease in V wave was associated with 49% increased likelihood for improvement in 6-minute walk (P=0.04). Similar model with V-wave change as a dichotomous variable showed that patients with a V-wave decrease of ≥11 mm Hg were 3.8× more likely to improve their 6MWT (P=0.05). Conclusions - Acute changes in LA pressure after MitraClip procedure are associated with clinical improvement as measured by 6MWT. Continuous LA pressure monitoring may be a useful tool for procedural guidance during transcatheter mitral repair.

KW - atrial pressure

KW - echocardiography

KW - exercise

KW - mitral valve

KW - walk test

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