Author + information
- Elad Maor,
- Claire Raphael,
- Sidakpal Panaich,
- Guy Reeder,
- Charanjit Rihal and
- Mackram Eleid
Background: Data on the clinical significance of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. The purpose of the current study was to evaluate the associated between acute intra-procedural changes in LA pressure following MitraClip and long term improvement in exercise capacity as documented by 6 minute walk test (6MWT).
Methods: Study population included 50 patients who underwent MitraClip in Mayo Clinic, Rochester between June 2014 and July 2016 and completed 6MWT at baseline and during follow-up. Clinical success was defined as 6MWT improvement above the median (24 meters).
Results: Mean age of the study population was 79±10 years and 33 (66%) were men. Baseline pre-procedural 6MWT distance was 312±99 meters. Acute, intra-procedural change in left atrial pressure following MitraClip was 3 mmHg (IQR 1-6 mm Hg) and change in V-wave was 11 mmHg (IQR 6-19 mmHg). Mean 6MWT improvement was 24±82 meters. Univariate analysis showed that patient with <=mild post-procedural mitral regurgitation (MR) were 3.8 fold more likely to improve their 6MWT (p=0.025). Multivariate binary logistic regression with adjustment for age and gender demonstrated that each 5 mmHg decrease is mean LA pressure following MitraClip procedure was associated with a significant 2.8-fold increased likelihood for improved 6MWT (OR = 2.76; 95% CI 1.06-7.21, p = 0.038). Similarly, each 5 mmHg decrease in V-wave was associated with 1.4-fold increased likelihood for improvement in 6 minute walk (OR = 1.43; 95% CI 1.01-2.04, p=0.046). When adjusted for age, gender and residual MR, the same model demonstrated a statistical trend towards an association between acute decrease in mean LA pressure and improved 6MWT (OR=1.46, p=0.052).
Conclusions: Acute changes in LA pressure following MitraClip procedure are associated with clinical improvement as documented by 6MWT. This study supports the importance of hemodynamic parameters for MitraClip procedural guidance.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Structural Heart Interventions: Focus on Mitral Valve, Left Atrial Appendage and HOCM
Abstract Category: 24. Interventional Cardiology: Mitral and Structural Heart Disease
Presentation Number: 1156-170
- 2017 American College of Cardiology Foundation