Myocardial fibrosis predicts adverse outcome after MitraClip implantation

Velu, Juliëtte F.; Hirsch, Alexander; Boekholdt, S. Matthijs; Koch, Karel T.; Vis, Marije M.; Planken, R. Nils; Piek, Jan J.; Baan, Jan; Bouma, Berto J.

doi:10.1002/ccd.27993

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…e presence of this nonischaemic pattern of LGE that appears to be in high prevalence in patients with MVP is not directly associated with the severity of the MR but has been repeatedly found to be a substrate for arrhythmic events [36][37][38]. e negative prognostic value of the presence of fibrosis may persist even after the intervention, although further large studies are needed to confirm a causal relationship between LGE and adverse events [39]. CMR has also contributed significantly to the identification of the entity of mitral annular disjunction as a common cause of arrhythmias [37].…”

Section: Mitral Regurgitationmentioning

confidence: 98%

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Tsampasian

Hothi

Ravindrarajah

et al. 2022

Cardiology Research and Practice

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Cardiovascular magnetic resonance (CMR) imaging has had a vast impact on the understanding of a wide range of disease processes and pathophysiological mechanisms. More recently, it has contributed significantly to the diagnosis and risk stratification of patients with valvular heart disease. With its increasing use, CMR allows for a detailed, reproducible, qualitative, and quantitative evaluation of left ventricular volumes and mass, thereby enabling assessment of the haemodynamic impact of a valvular lesion upon the myocardium. Postprocessing of the routinely acquired images with feature tracking CMR methodology can give invaluable information about myocardial deformation and strain parameters that suggest subclinical ventricular impairment that remains undetected by conventional measures such as the ejection fraction (EF). T1 mapping and late gadolinium enhancement (LGE) imaging provide deep myocardial tissue characterisation that is changing the approach towards risk stratification of patients as an increasing body of evidence suggests that the presence of fibrosis is related to adverse events and prognosis. This review summarises the current evidence regarding the utility of CMR in the left ventricular assessment of patients with aortic stenosis or mitral regurgitation and its value in diagnosis, risk stratification, and management.

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Section: Mitral Regurgitationmentioning

confidence: 98%

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Tsampasian

Hothi

Ravindrarajah

et al. 2022

Cardiology Research and Practice

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“…In an acute setting, other imaging techniques such as cardiac computed tomography or cardiac magnetic resonance are less commonly performed. In a non-acute scenario, LV fibrosis location and extension, assessed by late gadolinium enhancement in cardiac magnetic resonance, have been related reverse remodeling or clinical outcomes in patients undergoing surgical or transcatheter mitral correction (27,28).…”

Section: Imaging Techniquesmentioning

confidence: 99%

Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review

Estévez‐Loureiro

Silva

Baz-Alonso

et al. 2022

Front. Cardiovasc. Med.

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Acute mitral regurgitation (MR) may develop in the setting of an acute myocardial infarction (AMI) because of papillary muscle dysfunction or rupture. Severe acute MR in this scenario is a life-threatening complication associated with hemodynamic instability and pulmonary edema, and has been linked to a worse prognosis even after reperfusion. Patients treated solely with medical therapy have the highest mortality rates. Surgery has been the only treatment strategy until recently, but the results of the technique are hindered by high rates of morbidity and mortality. Therefore, the development of less invasive interventions for correcting MR would be ideal. We aimed to review the current role of transcatheter interventions in this clinical setting.

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“…The presence and extent of replacement myocardial fibrosis, as assessed by late gadolinium enhancement at CMR, is more frequent in secondary than in primary MR and predicts an adverse outcome after PMVR (28,68).…”

Section: Variables Before Pmvrmentioning

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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Myocardial fibrosis predicts adverse outcome after MitraClip implantation

Abstract: Background: High-risk patients with mitral regurgitation (

Cited by 12 publications

References 17 publications

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Percutaneous mitral valve repair in patients developing severe mitral regurgitation early after an acute myocardial infarction: A review

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

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