Quantitative Three-Dimensional Echocardiographic Correlates of Optimal Mitral Regurgitation Reduction during Transcatheter Mitral Valve Repair

Didem Oguz, Mackram Eleid, Sumandeep Dhesi, Sorin V. Pislaru, Sunil V. Mankad, Joseph F. Malouf, Vuyisile T Nkomo, Jae Kuen Oh, David Holmes, Guy S. Reeder, Charanjit Rihal, Jeremy J. Thaden

Research output: Contribution to journalArticle

Abstract

Background: Patient selection for transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging because of heterogenous mitral valve pathology and highly variable anatomy. The aim of this study was to investigate whether quantitative three-dimensional (3D) transesophageal echocardiographic modeling parameters are associated with optimal mitral regurgitation (MR) reduction in patients undergoing TMVR. Methods: Fifty-nine patients underwent 3D transesophageal echocardiography during TMVR. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software (Mitral Valve Navigator). Optimal MR reduction was defined as less than moderate residual MR. Logistic regression was used to correlate 3D transesophageal echocardiographic quantitative data to procedural success. Results: Thirty-five patients had primary MR, 24 had mixed or secondary MR, and all patients had grade ≥ 3/4 MR before the procedure. Optimal MR reduction was achieved in 40 of 59 patients (68%). Univariate correlates of optimal MR reduction in patients with primary MR were lower mitral leaflet tenting volume (P =.049) and lower tenting height (P =.025); tenting height < 3 mm and tenting volume < 0.7 mL were associated with increased likelihood of optimal MR reduction (92% vs 48% [P =.01] and 81% vs 47% [P =.03], respectively). In mixed or secondary MR, annular height ≥ 5.5 mm was associated with increased likelihood of optimal MR reduction (94% vs 38%; P =.03). During follow-up, redo TMVR or surgical mitral valve replacement occurred exclusively in patients with suboptimal anatomy defined by 3D transesophageal echocardiography (10% vs 0%, P =.045). Conclusions: Quantitative 3D echocardiographic data are associated with favorable response to TMVR and could help optimize patient selection.

Original languageEnglish (US)
JournalJournal of the American Society of Echocardiography
DOIs
StateAccepted/In press - Jan 1 2019

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Mitral Valve Insufficiency
Mitral Valve
Three-Dimensional Echocardiography
Transesophageal Echocardiography
Patient Selection
Anatomy
Surgical Instruments
Software
Logistic Models
Pathology

Keywords

  • 3D transesophageal echocardiography
  • MitraClip
  • Mitral regurgitation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Quantitative Three-Dimensional Echocardiographic Correlates of Optimal Mitral Regurgitation Reduction during Transcatheter Mitral Valve Repair. / Oguz, Didem; Eleid, Mackram; Dhesi, Sumandeep; Pislaru, Sorin V.; Mankad, Sunil V.; Malouf, Joseph F.; Nkomo, Vuyisile T; Oh, Jae Kuen; Holmes, David; Reeder, Guy S.; Rihal, Charanjit; Thaden, Jeremy J.

In: Journal of the American Society of Echocardiography, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Patient selection for transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging because of heterogenous mitral valve pathology and highly variable anatomy. The aim of this study was to investigate whether quantitative three-dimensional (3D) transesophageal echocardiographic modeling parameters are associated with optimal mitral regurgitation (MR) reduction in patients undergoing TMVR. Methods: Fifty-nine patients underwent 3D transesophageal echocardiography during TMVR. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software (Mitral Valve Navigator). Optimal MR reduction was defined as less than moderate residual MR. Logistic regression was used to correlate 3D transesophageal echocardiographic quantitative data to procedural success. Results: Thirty-five patients had primary MR, 24 had mixed or secondary MR, and all patients had grade ≥ 3/4 MR before the procedure. Optimal MR reduction was achieved in 40 of 59 patients (68{\%}). Univariate correlates of optimal MR reduction in patients with primary MR were lower mitral leaflet tenting volume (P =.049) and lower tenting height (P =.025); tenting height < 3 mm and tenting volume < 0.7 mL were associated with increased likelihood of optimal MR reduction (92{\%} vs 48{\%} [P =.01] and 81{\%} vs 47{\%} [P =.03], respectively). In mixed or secondary MR, annular height ≥ 5.5 mm was associated with increased likelihood of optimal MR reduction (94{\%} vs 38{\%}; P =.03). During follow-up, redo TMVR or surgical mitral valve replacement occurred exclusively in patients with suboptimal anatomy defined by 3D transesophageal echocardiography (10{\%} vs 0{\%}, P =.045). Conclusions: Quantitative 3D echocardiographic data are associated with favorable response to TMVR and could help optimize patient selection.",
keywords = "3D transesophageal echocardiography, MitraClip, Mitral regurgitation",
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T1 - Quantitative Three-Dimensional Echocardiographic Correlates of Optimal Mitral Regurgitation Reduction during Transcatheter Mitral Valve Repair

AU - Oguz, Didem

AU - Eleid, Mackram

AU - Dhesi, Sumandeep

AU - Pislaru, Sorin V.

AU - Mankad, Sunil V.

AU - Malouf, Joseph F.

AU - Nkomo, Vuyisile T

AU - Oh, Jae Kuen

AU - Holmes, David

AU - Reeder, Guy S.

AU - Rihal, Charanjit

AU - Thaden, Jeremy J.

PY - 2019/1/1

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N2 - Background: Patient selection for transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging because of heterogenous mitral valve pathology and highly variable anatomy. The aim of this study was to investigate whether quantitative three-dimensional (3D) transesophageal echocardiographic modeling parameters are associated with optimal mitral regurgitation (MR) reduction in patients undergoing TMVR. Methods: Fifty-nine patients underwent 3D transesophageal echocardiography during TMVR. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software (Mitral Valve Navigator). Optimal MR reduction was defined as less than moderate residual MR. Logistic regression was used to correlate 3D transesophageal echocardiographic quantitative data to procedural success. Results: Thirty-five patients had primary MR, 24 had mixed or secondary MR, and all patients had grade ≥ 3/4 MR before the procedure. Optimal MR reduction was achieved in 40 of 59 patients (68%). Univariate correlates of optimal MR reduction in patients with primary MR were lower mitral leaflet tenting volume (P =.049) and lower tenting height (P =.025); tenting height < 3 mm and tenting volume < 0.7 mL were associated with increased likelihood of optimal MR reduction (92% vs 48% [P =.01] and 81% vs 47% [P =.03], respectively). In mixed or secondary MR, annular height ≥ 5.5 mm was associated with increased likelihood of optimal MR reduction (94% vs 38%; P =.03). During follow-up, redo TMVR or surgical mitral valve replacement occurred exclusively in patients with suboptimal anatomy defined by 3D transesophageal echocardiography (10% vs 0%, P =.045). Conclusions: Quantitative 3D echocardiographic data are associated with favorable response to TMVR and could help optimize patient selection.

AB - Background: Patient selection for transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging because of heterogenous mitral valve pathology and highly variable anatomy. The aim of this study was to investigate whether quantitative three-dimensional (3D) transesophageal echocardiographic modeling parameters are associated with optimal mitral regurgitation (MR) reduction in patients undergoing TMVR. Methods: Fifty-nine patients underwent 3D transesophageal echocardiography during TMVR. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software (Mitral Valve Navigator). Optimal MR reduction was defined as less than moderate residual MR. Logistic regression was used to correlate 3D transesophageal echocardiographic quantitative data to procedural success. Results: Thirty-five patients had primary MR, 24 had mixed or secondary MR, and all patients had grade ≥ 3/4 MR before the procedure. Optimal MR reduction was achieved in 40 of 59 patients (68%). Univariate correlates of optimal MR reduction in patients with primary MR were lower mitral leaflet tenting volume (P =.049) and lower tenting height (P =.025); tenting height < 3 mm and tenting volume < 0.7 mL were associated with increased likelihood of optimal MR reduction (92% vs 48% [P =.01] and 81% vs 47% [P =.03], respectively). In mixed or secondary MR, annular height ≥ 5.5 mm was associated with increased likelihood of optimal MR reduction (94% vs 38%; P =.03). During follow-up, redo TMVR or surgical mitral valve replacement occurred exclusively in patients with suboptimal anatomy defined by 3D transesophageal echocardiography (10% vs 0%, P =.045). Conclusions: Quantitative 3D echocardiographic data are associated with favorable response to TMVR and could help optimize patient selection.

KW - 3D transesophageal echocardiography

KW - MitraClip

KW - Mitral regurgitation

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