Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair - Université de Rennes Accéder directement au contenu
Article Dans Une Revue Journal of Cardiovascular Development and Disease Année : 2023

Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair

Résumé

BACKGROUND: The noninvasive assessment of myocardial work (MW) allows for the evaluation of left ventricular (LV) performance by considering the effect of LV afterload. This study aims to evaluate the acute and chronic impact of transcatheter edge-to-edge repair (TEER) on MW parameters and LV remodeling in patients with severe primary mitral regurgitation (PMR). METHODS: A total of 71 patients (age: 77 ± 9 years, females: 44%) with moderate-to-severe or severe PMR (effective regurgitant orifice: 0.57 ± 0.31 cm(2); regurgitant volume: 80 ± 34 mL; LV end-systolic diameter: 42 ± 12 mm) underwent TEER after a global assessment by the heart team. MW indices were evaluated before the procedure, at hospital discharge, and at 1-year follow-up. LV remodeling was described as the percentage variation in LVEDV between baseline and 1-year follow-up. RESULTS: TEER caused an acute reduction in LVEF, global longitudinal strain (GLS), global MW index (GWI), work efficiency (GWE), and mechanical dispersion (MD) and a significant increase in wasted work (GWW). One year after the procedure, GLS, GWI, GWE, and MD recovered, whereas GWW remained significantly impaired. Baseline GWW (β = -0.29, p = 0.03) was an independent predictor of LV reverse remodeling at 1-year follow-up. CONCLUSIONS: In patients with severe PMR undergoing TEER, the acute reduction in LV preload causes significant impairment to all the parameters of LV performance. Baseline GWW was the only independent predictor of LV reverse remodeling, suggesting that a lower myocardial energetic efficiency in the context of chronic preload increase might impact the left ventricular response to mitral regurgitation correction.
Fichier principal
Vignette du fichier
jcdd-10-00100.pdf (1.36 Mo) Télécharger le fichier
Origine : Fichiers éditeurs autorisés sur une archive ouverte

Dates et versions

hal-04060972 , version 1 (06-04-2023)

Licence

Paternité

Identifiants

Citer

Elena Galli, Pierre Hubert, Guillaume Leurent, Vincent Auffret, Vasileios Panis, et al.. Acute and Chronic Changes in Myocardial Work Parameters in Patients with Severe Primary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. Journal of Cardiovascular Development and Disease, 2023, 10 (3), pp.100. ⟨10.3390/jcdd10030100⟩. ⟨hal-04060972⟩
16 Consultations
5 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More