- 作者：Kirsten Boerlage-van Dijk ; Annelieke C.M.J. van Riel ; Rianne H.A.C.M. de Bruin-Bon ; Esther M.A. Wiegerinck ; Karel T. Koch ; M. Marije Vis ; Paola G. Meregalli ; Navin R. Bindraban ; Barbara J.M. Mulder ; Jan J. Piek ; Berto J. Bouma ; Jan Baan Jr.
- 关键词：Mitral regurgitation ; MitraClip ; Transthoracic exercise echocardiography ; Mitral valve pressure gradient
- 刊名：Journal of the American Society of Echocardiography
- 出版年：January, 2014
- 年：2014
- 卷：27
- 期：1
- 页码：24-31.e1
- 全文大小：1099 K
Background
MitraClip implantation reduces mitral regurgitation effectively but decreases mitral valve area, creating iatrogenic mitral stenosis. Evaluation with transesophageal echocardiography intraprocedurally is necessary to measure mitral regurgitation and mitral valve pressure gradient (MVPG) to determine whether it is necessary and safe to place more clips. The aim of this study was to investigate whether these intraprocedural hemodynamics represent postprocedural measurements and whether exercise is affected by the stenosis.Methods
In this retrospective single-center study, 51 patients who underwent MitraClip implantation were included. Measurements were performed intraprocedurally using transesophageal echocardiography and postprocedurally using transthoracic echocardiography. In 23 of these patients, exercise echocardiography was performed at follow-up.
Results
Intraprocedural mean MVPG was 3.0 卤 1.6 mm Hg and increased to 4.3 卤 2.2 mm Hg postprocedurally (P < .001). During exercise, mean MVPG increased significantly compared with rest conditions (from聽3.6 卤 1.7 to 6.3 卤 2.7 mm Hg, P < .001). Six patients had mean resting MVPGs 鈮?5 mm Hg at follow-up and had higher systolic pulmonary artery pressure (sPAPs) than patients with mean MVPGs <聽5聽mm Hg (47聽卤 7 vs 35 卤 12 mm Hg, P聽= .035). Higher MVPG and sPAP did not lead to more symptoms of聽heart failure. Receiver operating characteristic curve analysis showed an estimated cutoff point for intraprocedural pressure half-time of 91 msec to identify patients with mitral stenosis and sPAP 鈮?50聽mm聽Hg postprocedurally.
Conclusions
Mean MVPG during MitraClip implantation measured by TEE underestimates the hemodynamics in daily life, of which operators should be aware when deciding on placing one or more clips. Pressure half-time seems to be the most robust parameter compared with mean and maximum MVPG and may contribute to this聽decision. Patients with higher mean MVPGs after MitraClip implantation have higher sPAPs at follow-up. However, more symptoms of heart failure were not detected at follow-up.