Predictive Factors for Progression of Mitral Regurgitation in Asymptomatic Patients With Mitral Valve Prolapse

Janet, I.; Igata, Sachiyo; Strachan, Monet; Nishimura, Marin; Wong, Darrin; Raisinghani, Ajit; DeMaria, Anthony N.

doi:10.1016/j.amjcard.2019.01.026

Cited by 13 publications

(11 citation statements)

References 17 publications

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“…If not treated, severe MR is associated with poor prognosis irrespective of its etiology, and heart failure (HF) symptoms development, new-onset atrial fibrillation, LV systolic dysfunction and increase in systolic pulmonary artery pressure (sPAP) constitute the main factors associated with worse outcomes [11][12][13][14][15].…”

Section: Pathophysiology and Natural Historymentioning

confidence: 99%

Percutaneous Mitral Valve Repair with the MitraClip System in the Current Clinical Practice

Sorrentino¹,

Berardini²,

Statuto³

et al. 2021

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Severe mitral valve regurgitation (MR) carries a significant burden both in prognosis and quality of life of patients, as well as on healthcare systems, with high rates of hospitalization for heart failure. While mitral valve surgery constitutes the first-line treatment option for primary MR in suitable patients, surgical treatment for secondary severe MR remains controversial, with a substantial lack of evidence on a survival benefit. In recent decades, percutaneous mitral valve repair has emerged as an alternative treatment for patients deemed not suitable for surgery. Among several devices under development or evaluation, the MitraClip system is the most widespread and is supported by the strongest evidence. While the role of MitraClip in patients with chronic primary MR who are not deemed suitable for surgery is well established, with consistent data showing improvement in both prognosis and quality of life, MitraClip treatment in secondary MR is a rapidly evolving field. Two recent randomized clinical trials generated apparently controversial results but actually provided an interesting pathophysiologic frame that could help discerning patients who will benefit from the procedure versus patients who will not. In this review, we will discuss current treatment options for mitral regurgitation, focusing on percutaneous mitral valve repair with the MitraClip system.

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Section: Pathophysiology and Natural Historymentioning

confidence: 99%

Percutaneous Mitral Valve Repair with the MitraClip System in the Current Clinical Practice

Sorrentino¹,

Berardini²,

Statuto³

et al. 2021

Hearts

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“…It is associated with a variable degree of MR, with most patient having trivial or mild regurgitation; previous studies have found a 6% prevalence of a severe degree of the disease in the outpatient population with valve prolapse [6,7] . However, very little data are available in these patients regarding the progression of MR severity and the associated risk factors [8,9] . Left untreated, chronic severe MR may lead to left ventricular (LV) remodeling because of volume overload, myocardial dysfunction, heart failure, left atrial dilatation, atrial fibrillation and pulmonary hypertension.…”

Section: Etiology and Treatment Of Primary Mrmentioning

confidence: 99%

Percutaneous “edge-to-edge” leaflet repair in patient with primary mitral valve regurgitation

Masiero¹,

Rodinò²,

Tarantini³

2020

MIS

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Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a constantly rising number of patients requiring hospitalization or intervention. Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus which may be caused by a broad set of pathological processes, among which myxomatous degeneration of the leaflets causing MV prolapse is the most common. If left untreated, chronic severe MR leads to serious adverse outcomes, from heart failure to death, but medical therapy is unable to change the natural history of the disease. Surgical correction, by means of valve repair or replacement, is the gold standard for the treatment of symptomatic patients with severe primary MR. However, surgery is not feasible for a large percentage of patients because of old age, reduced left ventricular ejection fraction and the presence of severe comorbidities. Therefore, in recent years, several percutaneous therapeutic alternatives suitable for high or prohibitive surgical risk patients were developed. In this review we discuss the transcatheter treatment of primary MR, from available evidence to technical practice, with a focus on the percutaneous "edge-to-edge" leaflet repair performed with the MitraClip System and the PASCAL Repair System.

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“…In one recent paper, the authors retrospectively followed 82 asymptomatic patients with MVP, normal ejection fraction and mild to moderate MR for a mean of 4.5 years. They found that none of the patients with mild MR progressed to severe MR, whereas 50% with moderate MR progressed to severe MR. No clinical variables or echocardiographic parameters predicted progression of disease apart from mitral annular diameter of 39.6 mm (sensitivity 100%, and specificity 63.8%)(27). The role for clinical variables such as male sex, older age, atrial fibrillation, higher weight and hypertension or echocardiographic parameters such as valvular thickening in predicting progression of disease is controversial (27–29).…”

Section: Management Of Chronic Mrmentioning

confidence: 99%

“…They found that none of the patients with mild MR progressed to severe MR, whereas 50% with moderate MR progressed to severe MR. No clinical variables or echocardiographic parameters predicted progression of disease apart from mitral annular diameter of 39.6 mm (sensitivity 100%, and specificity 63.8%)(27). The role for clinical variables such as male sex, older age, atrial fibrillation, higher weight and hypertension or echocardiographic parameters such as valvular thickening in predicting progression of disease is controversial (27–29). In summary, there are no clear predictors to which patients tend to progress, making serial clinical and echocardiographic monitoring standard of care while on medical therapy.…”

Section: Management Of Chronic Mrmentioning

confidence: 99%

Percutaneous Mitral Valve Interventions (Repair): Current Indications and Future Perspectives

Shah

Jorde

2019

Front. Cardiovasc. Med.

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Mitral valve regurgitation (MR) is the commonest valvular abnormality encountered among adult patients with cardiac valvular disease and conveys significant morbidity and mortality. The mitral valve is a complex anatomical structure and etiology for regurgitation is classified as either primary or secondary MR. Identification of the etiology in severe MR is critical in determining the appropriate treatment strategy. Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for treatment of selected patients with symptomatic chronic moderate-severe or severe (3 to 4+) MR. While surgery remains the mainstay for treatment in primary MR, several technological advances within the last decade have made transcatheter mitral valve intervention increasingly feasible and safe in clinical practice. Use of TMVR in patients with severe MR has successfully reduced patient symptoms, disease morbidity, improved quality of life, and facilitated reverse remodeling with potential for a survival advantage among certain patients with secondary MR. Recent randomized controlled trials on MitraClip use in secondary MR have reinvigorated interest in this disease and refocused our attention on optimizing patient selection and timing of intervention to maximize benefit from using such percutaneous devices. In our review, we discuss etiologies and pathophysiology in both acute MR and development of chronic severe MR. We discuss management strategies for MR among patients based on etiology, particularly percutaneous mitral valve interventional therapies. We perform an extensive review comparing and contrasting existing data on safety, efficacy, durability, and appropriate patient selection related to MitraClip implantation in both primary and secondary MR. Lastly, we explore percutaneous MV therapies beyond the MitraClip as we await larger scale trials on these devices prior to them making way into day-to-day practice.

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Predictive Factors for Progression of Mitral Regurgitation in Asymptomatic Patients With Mitral Valve Prolapse

Cited by 13 publications

References 17 publications

Percutaneous Mitral Valve Repair with the MitraClip System in the Current Clinical Practice

Percutaneous Mitral Valve Repair with the MitraClip System in the Current Clinical Practice

Percutaneous “edge-to-edge” leaflet repair in patient with primary mitral valve regurgitation

Percutaneous Mitral Valve Interventions (Repair): Current Indications and Future Perspectives

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