Novel Multiphase Assessment for Predicting Left Ventricular Outflow Tract Obstruction Before Transcatheter Mitral Valve Replacement

This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Patients considered for transcatheter mitral valve replacement trials often screen-fai...

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Veröffentlicht in:JACC. Cardiovascular interventions 2019-12, Vol.12 (23), p.2402-2412
Hauptverfasser: Meduri, Christopher U., Reardon, Michael J., Lim, D. Scott, Howard, Elliot, Dunnington, Gan, Lee, David P., Liang, David, Gooley, Robert, O’Hair, Daniel, Ng, Martin K., Walton, Antony, Spargias, Konstantinos, Blackman, Daniel, Coisne, Augustin, Hildick-Smith, David, De Gouy, Marine, Chenoweth, Sharla, Kar, Saibal, McCarthy, Patrick M., Piazza, Nicolo, Qasam, Atif, Martin, Randolph P., Leon, Martin B., Mack, Michael J., Adams, David H., Bapat, Vinayak
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container_end_page 2412
container_issue 23
container_start_page 2402
container_title JACC. Cardiovascular interventions
container_volume 12
creator Meduri, Christopher U.
Reardon, Michael J.
Lim, D. Scott
Howard, Elliot
Dunnington, Gan
Lee, David P.
Liang, David
Gooley, Robert
O’Hair, Daniel
Ng, Martin K.
Walton, Antony
Spargias, Konstantinos
Blackman, Daniel
Coisne, Augustin
Hildick-Smith, David
De Gouy, Marine
Chenoweth, Sharla
Kar, Saibal
McCarthy, Patrick M.
Piazza, Nicolo
Qasam, Atif
Martin, Randolph P.
Leon, Martin B.
Mack, Michael J.
Adams, David H.
Bapat, Vinayak
description This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Patients considered for transcatheter mitral valve replacement trials often screen-fail because of the perceived risk of LVOTO. In the Intrepid Global Pilot Study, assumed risk of LVOTO was based on computed tomography estimates of the neo-LVOT area computed at end-systole. However, this may overestimate actual risk. Retrospective analyses were performed for screen-failed patients for potential LVOTO (n = 33) and treated patients (n = 29) with available dynamic computed tomography. A multiphase assessment of the neo-LVOT area was performed and represented as: 1) multiphase average; and 2) early systolic value. Prospective evaluation was performed in 9 patients approved for enrollment with multiphase and early systole methods that would have previously screen-failed with the end-systolic approach. Of 166 patients screened for possible inclusion; 32 were screen-failed for nonanatomical reasons. Screen failure for assumed LVOTO risk occurred in 37 of 134 (27.6%) patients. Retrospective analysis indicated a potential enrollment increase of 11 of 33 (33.3%) and 18 of 33 (54.5%) patients using multiphase and early systolic assessment methods. In the prospective cohort, there were no clinical observations of LVOTO 30 days post-procedure, despite assumed risk based on end-systolic estimates. Multiphase, and specifically early systolic, assessment of the neo-LVOT may better determine risk of LVOTO with transcatheter mitral valve replacement compared with end-systolic estimates. This novel approach has the potential to significantly increase patient eligibility, with over one-half of patients previously screen-failed now eligible for treatment. [Display omitted]
doi_str_mv 10.1016/j.jcin.2019.06.015
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Scott ; Howard, Elliot ; Dunnington, Gan ; Lee, David P. ; Liang, David ; Gooley, Robert ; O’Hair, Daniel ; Ng, Martin K. ; Walton, Antony ; Spargias, Konstantinos ; Blackman, Daniel ; Coisne, Augustin ; Hildick-Smith, David ; De Gouy, Marine ; Chenoweth, Sharla ; Kar, Saibal ; McCarthy, Patrick M. ; Piazza, Nicolo ; Qasam, Atif ; Martin, Randolph P. ; Leon, Martin B. ; Mack, Michael J. ; Adams, David H. ; Bapat, Vinayak</creator><creatorcontrib>Meduri, Christopher U. ; Reardon, Michael J. ; Lim, D. Scott ; Howard, Elliot ; Dunnington, Gan ; Lee, David P. ; Liang, David ; Gooley, Robert ; O’Hair, Daniel ; Ng, Martin K. ; Walton, Antony ; Spargias, Konstantinos ; Blackman, Daniel ; Coisne, Augustin ; Hildick-Smith, David ; De Gouy, Marine ; Chenoweth, Sharla ; Kar, Saibal ; McCarthy, Patrick M. ; Piazza, Nicolo ; Qasam, Atif ; Martin, Randolph P. ; Leon, Martin B. ; Mack, Michael J. ; Adams, David H. ; Bapat, Vinayak</creatorcontrib><description>This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Patients considered for transcatheter mitral valve replacement trials often screen-fail because of the perceived risk of LVOTO. In the Intrepid Global Pilot Study, assumed risk of LVOTO was based on computed tomography estimates of the neo-LVOT area computed at end-systole. However, this may overestimate actual risk. 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Cardiovascular interventions</jtitle><date>2019-12-09</date><risdate>2019</risdate><volume>12</volume><issue>23</issue><spage>2402</spage><epage>2412</epage><pages>2402-2412</pages><issn>1936-8798</issn><eissn>1876-7605</eissn><abstract>This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Patients considered for transcatheter mitral valve replacement trials often screen-fail because of the perceived risk of LVOTO. In the Intrepid Global Pilot Study, assumed risk of LVOTO was based on computed tomography estimates of the neo-LVOT area computed at end-systole. However, this may overestimate actual risk. Retrospective analyses were performed for screen-failed patients for potential LVOTO (n = 33) and treated patients (n = 29) with available dynamic computed tomography. A multiphase assessment of the neo-LVOT area was performed and represented as: 1) multiphase average; and 2) early systolic value. Prospective evaluation was performed in 9 patients approved for enrollment with multiphase and early systole methods that would have previously screen-failed with the end-systolic approach. Of 166 patients screened for possible inclusion; 32 were screen-failed for nonanatomical reasons. Screen failure for assumed LVOTO risk occurred in 37 of 134 (27.6%) patients. Retrospective analysis indicated a potential enrollment increase of 11 of 33 (33.3%) and 18 of 33 (54.5%) patients using multiphase and early systolic assessment methods. In the prospective cohort, there were no clinical observations of LVOTO 30 days post-procedure, despite assumed risk based on end-systolic estimates. 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source Access via ScienceDirect (Elsevier); EZB-FREE-00999 freely available EZB journals
subjects left ventricular outflow tract obstruction
LVOT
mitral valve
neo-LVOT
TMVR
title Novel Multiphase Assessment for Predicting Left Ventricular Outflow Tract Obstruction Before Transcatheter Mitral Valve Replacement
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