Author + information
- Olivier Chiche,
- Josep Rodés-Cabau,
- Campelo-Parada Francisco,
- Ander Regueiro,
- Barria Alberto,
- Rodriguez-Gabella Tania,
- Robert DeLarochellière,
- Jean-Michel Paradis,
- Eric Dumont,
- Daniel Doyle,
- Siamak Mohammadi,
- Sebastien Bergeron,
- Philippe Pibarot and
- Jonathan Beaudoin
Background: Significant mitral regurgitation (MR) is associated with poor outcomes after transcatheter aortic valve replacement (TAVR). Although MR severity can decrease in a subset of patients after TAVR, predictors of such improvement have not been studied thoroughly. Better prediction of MR evolution could influence clinical management when intervention on both valves is considered.
Objectives: To explore clinical and imaging (cardiac CT and echocardiography) predictors of MR improvement after TAVR.
Methods: We analyzed all consecutive patients treated with TAVR in our center that presented with more than mild MR at baseline. MR evolution was assessed early (1-3 months) and late (6-12 months) after intervention. MR severity, mechanisms and geometric variables were assessed by echocardiography. Mitral annulus calcifications (MAC) were quantified with calcium scoring from the preoperative cardiac CT.
Results: A total of 78 patients were studied. MR improved in 34 patients (43%), remained stable in 38 (49%) and worsened in 6 (8%) at 6-12 months of follow-up. Patients improving MR 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), left ventricular end-systolic (34±19 vs 23±16 ml/m2, p<0.01) and end-diastolic (61.2±21.4 vs 50.3±16.7 ml/m2, p=0.02) indexed volumes, and lower ejection fraction (43±16% vs 52±14%, p=0.01). These parameters improved overtime in patients with MR reduction. MAC was frequent (87.7% of patients) and a trend in greater annular calcium was observed in patients without MR improvement (3560±5587 vs 2053±2800 HU, p=0.16). Extensive calcifications associated with restricted leaflet motion were associated with MR non-improvement (p<0.001). In multivariable analyses, tenting area (OR per 10 mm2 increase: 1.012, 95% CI, 1.001-1.024 p=0.039) and calcifications associated with leaflet restriction (OR= 0.108, 95% CI, 0.012-0.956, p=0.045) were independent predictors of MR improvement.
Conclusions: Preoperative imaging variables can help predict MR improvement after TAVR. This may help in the clinical decision-making process of TAVR candidates with concomitant MR.
Moderated Poster Contributions
Interventional Cardiology Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 12:30 p.m.-12:40 p.m.
Session Title: Frontiers in Mitral Valve Disease and Treatment
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1316M-03
- 2017 American College of Cardiology Foundation