Page 102 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter five. MV geometry: The COAPT Trial
area (EROA) of 0.41 cm2, regurgitant volume of 26.8 ml/beat and regurgitant fraction of 36.4%. Moderately severe LV remodeling was observed with a mean LV end-systolic diameter of 5.3 cm and end-diastolic diameter of 6.2 cm. Mean LV end-systolic volume was 134.7 ml and end-diastolic volume 192.8 ml resulting in a mean LV ejection fraction of 31.3%. Mean right ventricular fractional area change was impaired with a mean value of 32.0%. The mean right ventricular systolic pressure (RVSP) was increased (44.3 ± 13.7 mmHg) and the majority of patients had mild tricuspid regurgitation.
Impact of mitral valve geometry and cardiac structure and function on MR reduction
Among 274 patients who were randomized to and treated with the MitraClip, at 30 days grade 0 or 1+ MR was present in 199 patients (72.6%), grade 2+ MR was present in 54 patients (19.7%) and grade 3+ or 4+ MR was present in 21 patients (7.7%). As shown in Table 3, patients with 3+ or 4+ MR at 30 days post-MitraClip had a significantly larger mitral posterior leaflet angle at baseline than those with £2+ MR. The tethering location was also significantly different between the groups; specifically, while mitral leaflet tethering at P3 was uncommon (7 patients), 3 of these patients (42.9%) had 33+ MR at 30 days after MitraClip. No other significant differences were observed in mitral valve geometry at baseline according to MR grade 30 days after MitraClip. In terms of conventional echocardiographic characteristics, patients with grade 3+ or 4+ MR 30- days after MitraClip had more severe MR at baseline, larger total stroke volume, larger LV end-diastolic volume index and higher RVSPs.
Table 2. Echocardiographic characteristics at baseline for the total population.
Mitral valve geometrical measurements
Intercommissural mitral valve annulus diameter (cm) Anteroposterior mitral valve annulus diameter (cm) Coaptation to septum distance (cm)
Tenting height (mm)
Tenting area (cm2)
Anterior mitral valve leaflet length (cm) Posterior mitral valve leaflet length (cm) Tethering location, n/N (%)
None P1 P1-P2 P2 P2-P3 P3
All
3.56 ± 0.43 (577) 3.26 ± 0.39 (575) 4.04 ± 0.46 (559) 9.9 ± 2.4 (569) 2.16 ± 0.68 (568) 2.25 ± 0.37 (551) 1.35 ± 0.24 (472)
21/465 (4.5) 60/465 (12.9) 109/465 (23.4) 183/465 (39.4) 68/465 (14.6) 22/465 (4.7) 2/465 (0.4)
100