Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair?

Velu, Juliëtte F.; Baan, Jan; Bruin-Bon, H A C M De; Mourik, Martijn S. van; Nassif, Martina; Koch, Karel T.; Vis, Marije M.; Brink, R. B. van den; Boekholdt, S. Matthijs; Piek, Jan J.; Bouma, Berto J.

doi:10.1007/s10554-018-1507-x

Cited by 10 publications

(16 citation statements)

References 30 publications

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“…In addition, HG has been used in echocardiography as a means of stress test to identify exertion induced ischemia or exertion induced left ventricular diastolic dysfunction [ 2 , 3 ]. Furthermore, HG has been used in combination with dobutamine stress echocardiography to identify patients with MR who would probably benefit from percutaneous mitral valve repair [ 4 ]. However, there is no existing data describing the effect of isolated HG on the severity of MR.…”

Section: Introductionmentioning

confidence: 99%

Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation

Alachkar

Kirschfink

Grebe

et al. 2020

Int J Cardiovasc Imaging

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Handgrip exercise (HG) has been occasionally used as a stress test in echocardiography. The effect of HG on mitral regurgitation (MR) is not well known. This study aims to evaluate this effect and the possible role of HG in the echocardiographic evaluation of MR. 722 patients with MR were included (18% primary, 82% secondary disease). We calculated effective regurgitant orifice area (EROA) and regurgitant volume (RVOL) at rest and during dynamic HG. Increase in MR was defined as any increase in EROA or RVOL. We analyzed the data to identify possible associations between clinical or echocardiographic parameters and the effect of HG on MR. MR increased during dynamic HG in 390 of 722 patients (54%) (∆EROA = 25%, ∆RVOL = 27%). Increase of regurgitation occurred in 66 of 132 patients with primary MR (50%) and in 324 of 580 patients with secondary MR (55%). This increase was associated with larger baseline EROA and RVOL, but it was independent from other clinical or echocardiographic parameters. In secondary MR, dynamic HG led to a reclassification of regurgitation severity from non-severe at rest to severe MR during HG in 104 of 375 patients (28%). There was a significant association between this upgrade in MR classification and higher New York Heart Association (NYHA) class (OR 1.486, 95%-CI 1.138–1.940, p = 0.004). Dynamic HG exercise increases MR in about half of patients independent of the etiology. Dynamic HG may be used to identify symptomatic patients with non-severe secondary MR at rest but severe MR during exercise.

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Section: Introductionmentioning

confidence: 99%

Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation

Alachkar

Kirschfink

Grebe

et al. 2020

Int J Cardiovasc Imaging

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“…In secondary MR, an exercise increase in EROA > 0.13 cm 2 and sPAP > 60 mmHg carry a poor prognosis [12] , while MR decrease with exercise because of improvement of walls motion, recruitment of ischemic segments, and ultimately reduction of the tethering forces could identify patients who would benefit from optimal medical therapy and revascularization prior to the correction of mitral disease [13] . On this basis, a study on 39 patients treated with MitraClip confirmed that a decrease in MR grade during stress echo was associated with limited clinical benefit from the procedure [14] .…”

Section: Echocardiographymentioning

confidence: 96%

Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Melillo¹,

Boccellino²,

Ingallina³

et al. 2020

Mini-invasive Surg

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New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

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“…Stress echocardiography, beyond the definition of MR relevance, may also help to identify patients who derive benefit from MitraClip: subjects who experience a reduction in MR severity during preprocedural low-dose stress (dobutamine or handgrip) echocardiography remain more symptomatic after intervention compared with those presenting with stable or increased MR during preprocedural stress, likely because in these patients MR might have contributed less to their symptoms during exercise, thus explaining the lack of benefit from a technically successful MitraClip procedure ( 75 ). Similarly, stress echocardiography may identify the optimal timing of PMVR at an earlier stage: patients with moderate resting developing severe exercise-induced MR during handgrip echocardiography have an improved treatment response after MitraClip ( 76 ).…”

Section: Beyond Baseline Evaluation Of MV and Lv Morphologymentioning

confidence: 99%

“…However, clinical experience and published data also highlight the need to consider several additional factors, including the presence of severe RV dysfunction, advanced LV impairment (typically associated with very high BNP values), and an irreversible precapillary component of pulmonary hypertension ( 92 ), that can attenuate the benefit of PMVR and predict potential futility. Where doubt remains, functional testing to assess ventricular reserve ( 75 , 83 ) and dynamic RV-to-pulmonary circulation uncoupling ( 82 , 93 ) can be useful for further risk stratification. Furthermore, risk associated with ischemic MR has been more comprehensively described as an interaction between MR severity and myocardial infarct size by CMR imaging, lending an opportunity for improved risk stratification beyond LV volumes and clinical parameters, and for the individualization of treatment decision ( Figure 9 ).…”

Section: The Selection Of the Optimal Candidatementioning

confidence: 99%

Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology

Salvatore

Ricci

Dangas

et al. 2021

Front. Cardiovasc. Med.

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Secondary mitral regurgitation (MR) occurs despite structurally normal valve apparatus due to an underlying disease of the myocardium leading to disruption of the balance between tethering and closing forces with ensuing failure of leaflet coaptation. In patients with heart failure (HF) and left ventricular dysfunction, secondary MR is independently associated with poor outcome, yet prognostic benefits related to the correction of MR have remained elusive. Surgery is not recommended for the correction of secondary MR outside coronary artery bypass grafting. Percutaneous mitral valve repair (PMVR) with MitraClip implantation has recently evolved as a new transcatheter treatment option of inoperable or high-risk patients with severe MR, with promising results supporting the extension of guideline recommendations. MitraClip is highly effective in reducing secondary MR in HF patients. However, the derived clinical benefit is still controversial as two randomized trials directly comparing PMVR vs. optimal medical therapy in severe secondary MR yielded virtually opposite conclusions. We reviewed current evidence to identify predictors of PMVR-related outcomes in secondary MR useful to improve the timing and the selection of patients who would derive maximal benefit from MitraClip intervention. Beyond mitral valve anatomy, optimal candidate selection should rely on a comprehensive diagnostic workup and a fine-tuned risk stratification process aimed at (i) recognizing the substantial heterogeneity of secondary MR and its complex interaction with the myocardium, (ii) foreseeing hemodynamic consequences of PMVR, (iii) anticipating futility and (iv) improving symptoms, quality of life and overall survival.

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Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair?

Cited by 10 publications

References 30 publications

Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation

Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation

Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology

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