Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement
Background Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly. Methods Retrospective analysis of consecutive patients treated with TAVR...
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| Veröffentlicht in: | Echocardiography (Mount Kisco, N.Y.) N.Y.), 2019-04, Vol.36 (4), p.722-731 |
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| creator | Chiche, Olivier Rodés‐Cabau, Josep Campelo‐Parada, Francisco Freitas‐Ferraz, Afonso B. Regueiro, Ander Chamandi, Chekrallah Rodriguez‐Gabella, Tania Côté, Mélanie DeLarochellière, Robert Paradis, Jean‐Michel Dumont, Eric Doyle, Daniel Mohammadi, Siamak Bergeron, Sébastien Pibarot, Philippe Beaudoin, Jonathan |
| description | Background
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly.
Methods
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
Results
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P |
| doi_str_mv | 10.1111/echo.14303 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2188205415</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2188205415</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3293-cbc183f0a3fccc2f6026c9e3ec900159ef1ff0ecd555c01f6d69b16102303fe73</originalsourceid><addsrcrecordid>eNp9kE1P3DAQQC0Egi3thR-AfERIgRk7zgc3tKIFCYTU0l4jrzMORomztRMQ_Pp6WdpjfbFlP72RH2NHCGeY1jmZx_EMcwlyhy1Q5ZBVWKpdtoAyF5mohDhgn2J8AoASMd9nBxIqmauyXrC3H67zzjqj_cQHNwXd80DdHDo36cmNnjvP1-lEfop89i2FbnS-4w-Xv75f8Ls0W3sXh8i1b7kbdLd5fNbB6VVP6TbG0Tg9Uctf3PSYiHUYn2lIus9sz-o-0peP_ZD9_Hr1sLzObu-_3SwvbzMjRS0zszJYSQtaWmOMsAWIwtQkydQAqGqyaC2QaZVSBtAWbVGvsEAQKYilUh6yk603Tf49U5yawUVDfa89jXNsBFaVAJWjSujpFjVhjDGQbdYh_Sm8NgjNpnWzad28t07w8Yd3Xg3U_kP_xk0AboEX19Prf1TN1fL6fiv9A1ujjC4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2188205415</pqid></control><display><type>article</type><title>Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Chiche, Olivier ; Rodés‐Cabau, Josep ; Campelo‐Parada, Francisco ; Freitas‐Ferraz, Afonso B. ; Regueiro, Ander ; Chamandi, Chekrallah ; Rodriguez‐Gabella, Tania ; Côté, Mélanie ; DeLarochellière, Robert ; Paradis, Jean‐Michel ; Dumont, Eric ; Doyle, Daniel ; Mohammadi, Siamak ; Bergeron, Sébastien ; Pibarot, Philippe ; Beaudoin, Jonathan</creator><creatorcontrib>Chiche, Olivier ; Rodés‐Cabau, Josep ; Campelo‐Parada, Francisco ; Freitas‐Ferraz, Afonso B. ; Regueiro, Ander ; Chamandi, Chekrallah ; Rodriguez‐Gabella, Tania ; Côté, Mélanie ; DeLarochellière, Robert ; Paradis, Jean‐Michel ; Dumont, Eric ; Doyle, Daniel ; Mohammadi, Siamak ; Bergeron, Sébastien ; Pibarot, Philippe ; Beaudoin, Jonathan</creatorcontrib><description>Background
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly.
Methods
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
Results
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001–1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012–0.956, P = 0.045) were independently associated with MR outcome after TAVR.
Conclusion
Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision‐making process of TAVR candidates with concomitant MR.</description><identifier>ISSN: 0742-2822</identifier><identifier>EISSN: 1540-8175</identifier><identifier>DOI: 10.1111/echo.14303</identifier><identifier>PMID: 30834579</identifier><language>eng</language><publisher>United States</publisher><subject>Aged, 80 and over ; Aortic Valve - diagnostic imaging ; Aortic Valve - physiopathology ; aortic valve replacement ; computed tomography ; echocardiography ; Echocardiography - methods ; Female ; Follow-Up Studies ; Humans ; Male ; mitral regurgitation ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - physiopathology ; Postoperative Complications - diagnostic imaging ; Postoperative Complications - physiopathology ; Retrospective Studies ; Severity of Illness Index ; Transcatheter Aortic Valve Replacement ; Treatment Outcome</subject><ispartof>Echocardiography (Mount Kisco, N.Y.), 2019-04, Vol.36 (4), p.722-731</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3293-cbc183f0a3fccc2f6026c9e3ec900159ef1ff0ecd555c01f6d69b16102303fe73</citedby><cites>FETCH-LOGICAL-c3293-cbc183f0a3fccc2f6026c9e3ec900159ef1ff0ecd555c01f6d69b16102303fe73</cites><orcidid>0000-0002-8958-6823 ; 0000-0002-9914-6821</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fecho.14303$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fecho.14303$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30834579$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chiche, Olivier</creatorcontrib><creatorcontrib>Rodés‐Cabau, Josep</creatorcontrib><creatorcontrib>Campelo‐Parada, Francisco</creatorcontrib><creatorcontrib>Freitas‐Ferraz, Afonso B.</creatorcontrib><creatorcontrib>Regueiro, Ander</creatorcontrib><creatorcontrib>Chamandi, Chekrallah</creatorcontrib><creatorcontrib>Rodriguez‐Gabella, Tania</creatorcontrib><creatorcontrib>Côté, Mélanie</creatorcontrib><creatorcontrib>DeLarochellière, Robert</creatorcontrib><creatorcontrib>Paradis, Jean‐Michel</creatorcontrib><creatorcontrib>Dumont, Eric</creatorcontrib><creatorcontrib>Doyle, Daniel</creatorcontrib><creatorcontrib>Mohammadi, Siamak</creatorcontrib><creatorcontrib>Bergeron, Sébastien</creatorcontrib><creatorcontrib>Pibarot, Philippe</creatorcontrib><creatorcontrib>Beaudoin, Jonathan</creatorcontrib><title>Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement</title><title>Echocardiography (Mount Kisco, N.Y.)</title><addtitle>Echocardiography</addtitle><description>Background
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly.
Methods
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
Results
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001–1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012–0.956, P = 0.045) were independently associated with MR outcome after TAVR.
Conclusion
Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision‐making process of TAVR candidates with concomitant MR.</description><subject>Aged, 80 and over</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - physiopathology</subject><subject>aortic valve replacement</subject><subject>computed tomography</subject><subject>echocardiography</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>mitral regurgitation</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Postoperative Complications - physiopathology</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Transcatheter Aortic Valve Replacement</subject><subject>Treatment Outcome</subject><issn>0742-2822</issn><issn>1540-8175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQQC0Egi3thR-AfERIgRk7zgc3tKIFCYTU0l4jrzMORomztRMQ_Pp6WdpjfbFlP72RH2NHCGeY1jmZx_EMcwlyhy1Q5ZBVWKpdtoAyF5mohDhgn2J8AoASMd9nBxIqmauyXrC3H67zzjqj_cQHNwXd80DdHDo36cmNnjvP1-lEfop89i2FbnS-4w-Xv75f8Ls0W3sXh8i1b7kbdLd5fNbB6VVP6TbG0Tg9Uctf3PSYiHUYn2lIus9sz-o-0peP_ZD9_Hr1sLzObu-_3SwvbzMjRS0zszJYSQtaWmOMsAWIwtQkydQAqGqyaC2QaZVSBtAWbVGvsEAQKYilUh6yk603Tf49U5yawUVDfa89jXNsBFaVAJWjSujpFjVhjDGQbdYh_Sm8NgjNpnWzad28t07w8Yd3Xg3U_kP_xk0AboEX19Prf1TN1fL6fiv9A1ujjC4</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Chiche, Olivier</creator><creator>Rodés‐Cabau, Josep</creator><creator>Campelo‐Parada, Francisco</creator><creator>Freitas‐Ferraz, Afonso B.</creator><creator>Regueiro, Ander</creator><creator>Chamandi, Chekrallah</creator><creator>Rodriguez‐Gabella, Tania</creator><creator>Côté, Mélanie</creator><creator>DeLarochellière, Robert</creator><creator>Paradis, Jean‐Michel</creator><creator>Dumont, Eric</creator><creator>Doyle, Daniel</creator><creator>Mohammadi, Siamak</creator><creator>Bergeron, Sébastien</creator><creator>Pibarot, Philippe</creator><creator>Beaudoin, Jonathan</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8958-6823</orcidid><orcidid>https://orcid.org/0000-0002-9914-6821</orcidid></search><sort><creationdate>201904</creationdate><title>Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement</title><author>Chiche, Olivier ; Rodés‐Cabau, Josep ; Campelo‐Parada, Francisco ; Freitas‐Ferraz, Afonso B. ; Regueiro, Ander ; Chamandi, Chekrallah ; Rodriguez‐Gabella, Tania ; Côté, Mélanie ; DeLarochellière, Robert ; Paradis, Jean‐Michel ; Dumont, Eric ; Doyle, Daniel ; Mohammadi, Siamak ; Bergeron, Sébastien ; Pibarot, Philippe ; Beaudoin, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3293-cbc183f0a3fccc2f6026c9e3ec900159ef1ff0ecd555c01f6d69b16102303fe73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged, 80 and over</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - physiopathology</topic><topic>aortic valve replacement</topic><topic>computed tomography</topic><topic>echocardiography</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>mitral regurgitation</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Postoperative Complications - physiopathology</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Transcatheter Aortic Valve Replacement</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chiche, Olivier</creatorcontrib><creatorcontrib>Rodés‐Cabau, Josep</creatorcontrib><creatorcontrib>Campelo‐Parada, Francisco</creatorcontrib><creatorcontrib>Freitas‐Ferraz, Afonso B.</creatorcontrib><creatorcontrib>Regueiro, Ander</creatorcontrib><creatorcontrib>Chamandi, Chekrallah</creatorcontrib><creatorcontrib>Rodriguez‐Gabella, Tania</creatorcontrib><creatorcontrib>Côté, Mélanie</creatorcontrib><creatorcontrib>DeLarochellière, Robert</creatorcontrib><creatorcontrib>Paradis, Jean‐Michel</creatorcontrib><creatorcontrib>Dumont, Eric</creatorcontrib><creatorcontrib>Doyle, Daniel</creatorcontrib><creatorcontrib>Mohammadi, Siamak</creatorcontrib><creatorcontrib>Bergeron, Sébastien</creatorcontrib><creatorcontrib>Pibarot, Philippe</creatorcontrib><creatorcontrib>Beaudoin, Jonathan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chiche, Olivier</au><au>Rodés‐Cabau, Josep</au><au>Campelo‐Parada, Francisco</au><au>Freitas‐Ferraz, Afonso B.</au><au>Regueiro, Ander</au><au>Chamandi, Chekrallah</au><au>Rodriguez‐Gabella, Tania</au><au>Côté, Mélanie</au><au>DeLarochellière, Robert</au><au>Paradis, Jean‐Michel</au><au>Dumont, Eric</au><au>Doyle, Daniel</au><au>Mohammadi, Siamak</au><au>Bergeron, Sébastien</au><au>Pibarot, Philippe</au><au>Beaudoin, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement</atitle><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle><addtitle>Echocardiography</addtitle><date>2019-04</date><risdate>2019</risdate><volume>36</volume><issue>4</issue><spage>722</spage><epage>731</epage><pages>722-731</pages><issn>0742-2822</issn><eissn>1540-8175</eissn><abstract>Background
Significant mitral regurgitation (MR) is associated with poorer outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Factors associated with MR improvement have not been studied thoroughly.
Methods
Retrospective analysis of consecutive patients treated with TAVR with more than mild MR at baseline. MR evolution was assessed at 1–3 and 6–12 months after intervention. MR severity and mechanisms were assessed by echocardiography. Mitral annulus calcification (MAC) was quantified using preoperative cardiac CT.
Results
From 674 consecutive TAVR recipients, 78 with more than mild MR had a 6–12 months follow‐up. Following TAVR, MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%). Patients with MR improvement had greater tenting area (141 ± 56 vs. 99 ± 40 mm2, P < 0.01), tenting height (7.2 ± 1.9 vs. 5.6 ± 1.9 mm, P < 0.01) and lower ejection fraction (43 ± 16 vs. 52 ± 14%, P = 0.01). MAC was frequent (87.7% of patients) and a trend in greater MAC was observed in patients without MR improvement (3560 ± 5587 vs. 2053 ± 2800, P = 0.16). In multivariable analysis, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001–1.024 P = 0.039) and annulus calcifications associated with leaflet restriction (OR = 0.108, 95% CI, 0.012–0.956, P = 0.045) were independently associated with MR outcome after TAVR.
Conclusion
Larger mitral valve tenting area was associated with more improvement of MR after TAVR whereas extensive MAC associated with leaflet restriction was associated with less improvement. This may help in the clinical decision‐making process of TAVR candidates with concomitant MR.</abstract><cop>United States</cop><pmid>30834579</pmid><doi>10.1111/echo.14303</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8958-6823</orcidid><orcidid>https://orcid.org/0000-0002-9914-6821</orcidid></addata></record> |
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| subjects | Aged, 80 and over Aortic Valve - diagnostic imaging Aortic Valve - physiopathology aortic valve replacement computed tomography echocardiography Echocardiography - methods Female Follow-Up Studies Humans Male mitral regurgitation Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - physiopathology Postoperative Complications - diagnostic imaging Postoperative Complications - physiopathology Retrospective Studies Severity of Illness Index Transcatheter Aortic Valve Replacement Treatment Outcome |
| title | Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement |
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