Secondary Mitral Regurgitation in Heart Failure

Asgar, Anita W.; Mack, Michael J.; Stone, Gregg W.

doi:10.1016/j.jacc.2015.02.009

Cited by 399 publications

(118 citation statements)

References 106 publications

(25 reference statements)

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“…Severe functional mitral regurgitation is a frequent co‐morbidity in patients with chronic systolic heart failure, with an adverse impact on prognosis of patients regardless whether they suffer from ischaemic or non‐ischaemic cardiomyopathy 12. In a considerable number of these patients, surgery is associated with unacceptable risk; thus, a less invasive, interventional approach using the MitraClip® system may be recommended by the interdisciplinary heart team 13, 14…”

Section: Introductionmentioning

confidence: 99%

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

et al. 2018

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AimPatients with advanced systolic chronic heart failure frequently suffer from progressive functional mitral regurgitation. We report our initial experience in patients with an implanted pulmonary artery pressure (PAP) sensor, who developed severe mitral regurgitation, which was treated with the MitraClip system. We non‐invasively compared changes in PAP values in patients after MitraClip with PAP changes in patients without MitraClip.Methods and resultsAmong 28 patients with New York Heart Association III heart failure with implanted PAP sensor for haemodynamic telemonitoring from a single centre, four patients (age 66 ± 6 years, left ventricular ejection fraction 21 ± 3%, and cardiac index 1.8 ± 0.3) received a MitraClip procedure and were compared with 24 patients (age 72 ± 8 years, left ventricular ejection fraction 26 ± 9.9%, and cardiac index 2.0 ± 1.0) without MitraClip procedure in a descriptive manner. Ambulatory PAP values were followed for 90 days in both groups. In comparison with the PAP values 4 weeks before MitraClip procedure, PAP was profoundly reduced in all four patients after 30 days (ΔPAPmean −11 ± 5, ΔPAPdiast −7 ± 3 mmHg, P < 0.02) as well as after 90 days (ΔPAPmean −6.3 ± 6, ΔPAPdiast −1 ± 3 mmHg). Reductions in PAP were accompanied by a profound reduction in N terminal pro brain natriuretic peptide as well as clinical and echocardiographic improvement. When analysing the dynamics with a regression model, reductions in all PAP values were significantly greater after MitraClip compared with conservative haemodynamic monitoring (P < 0.001).ConclusionsThe efficacy of the interventional MitraClip procedure on clinical symptoms can be confirmed by haemodynamic telemonitoring. Thus, daily non‐invasive haemodynamic telemonitoring allows, for the first time, for a continuous assessment of the haemodynamic efficacy of novel therapies in patients with chronic heart failure.

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Section: Introductionmentioning

confidence: 99%

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

et al. 2018

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“…Exercise-induced increase in secondary MR is associated with poor exercise capacity 54, 59, 63 and outcomes 9, 64–67 (Figure 6). In a mixed cohort of ischemic and non-ischemic cardiomyopathy, Lapu-Bula et al 54 were the first to demonstrate a significant negative impact of exercise-induced MR deterioration on exercise capacity, even though MR was only mild-to-moderate at rest.…”

Section: Prognostic and Functional Impact Of The Dynamic Lesion Of MImentioning

confidence: 99%

“…A complete and detailed overview of the evidence for the various therapeutic approaches for secondary MR, comprising guideline-directed HF medication, CRT, revascularization when appropriate, as well as mitral valve surgery and transcatheter interventions 67 , is beyond the scope of this review. Instead, a critical evaluation of the (potential) impact of these therapies on the dynamic lesion in secondary MR is made based on the underlying determinants causing exercise-induced MR aggravation (Figure 7).…”

Section: Impact Of Treatment Approaches For Secondary Mr On Exercise mentioning

confidence: 99%

Exercise Dynamics in Secondary Mitral Regurgitation

et al. 2017

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Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic work-up and treatment of heart failure patients. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. Exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of HF patients it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, and in particular of the dynamic component during exercise is of timely importance. This review summarizes the pathophysiologic mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.

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“…Treatment for symptomatic functional MR with guidelinedirected medical therapy and cardiac resynchronization therapy improves symptoms and long-term outcomes. 17 Most of the commercial experience till date in functional MR patients is from Europe, since Conformité Européenne (CE) mark was granted 5 years prior to FDA approval.…”

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confidence: 99%

Percutaneous mitral valve repair: A new treatment for mitral regurgitation

Kelley

Lazkani

Farah

et al. 2016

Indian Heart Journal

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Mitral valve disease affects more than 4 million people in the United States. The gold standard of treatment in these patients is surgical repair or replacement of the valve with a prosthesis. The MitraClip (Abbott Vascular, Menlo Park, CA) is a new technology, which offers an alternative to open surgical repair or replacement via a minimally invasive route. We present an evidence-based clinical update that provides an overview of this technology as it relates to managing patients with significant mitral regurgitation. This review article is particularly useful to noninterventional cardiologists and interventional cardiologists who will be managing patients with this novel technology in increased volumes over the next decade but who do not perform this procedure.

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Secondary Mitral Regurgitation in Heart Failure

Cited by 399 publications

References 106 publications

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

Daily non‐invasive haemodynamic telemonitoring for efficacy evaluation of MitraClip® implantation in patients with advanced systolic heart failure

Exercise Dynamics in Secondary Mitral Regurgitation

Percutaneous mitral valve repair: A new treatment for mitral regurgitation

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