Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation

Joris F. Ooms; Sjoerd Bouwmeester; Philippe Debonnaire; Riwa Nasser; Jens Uwe Voigt; Mark A. Schotborgh; Marcel L. Geleijnse; Isabella Kardys; Ernest Spitzer; Joost Daemen; Peter P. De Jaegere; Patrick Houthuizen; Martin J. Swaans; Christophe Dubois; Marc Claeys; Jan Van Der Heyden; Pim A. Tonino; Nicolas M. Van Mieghem

doi:10.1016/j.echo.2021.08.002

Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation

Joris F. Ooms, Sjoerd Bouwmeester, Philippe Debonnaire, Riwa Nasser, Jens Uwe Voigt, Mark A. Schotborgh, Marcel L. Geleijnse, Isabella Kardys, Ernest Spitzer, Joost Daemen, Peter P. De Jaegere, Patrick Houthuizen, Martin J. Swaans, Christophe Dubois, Marc Claeys, Jan Van Der Heyden, Pim A. Tonino, Nicolas M. Van Mieghem^*

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). Methods: This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. Results: Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30% (interquartile range [IQR], 25%–35%), 27 mm², and 107 mL/m² (IQR, 90–135 mL/m²), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10–0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32% [IQR, 27%–39%] vs 26% [IQR, 22%–33%]; P <.01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95% CI, 0.28–0.74; P <.01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95% CI, 0.53–1.63; P =.80). Overall, in 35% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30% (n = 66) and 37% (n = 76), with no differences between dFMR and pFMR. Conclusions: TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders.

Original language	English
Pages (from-to)	105-115.e8
Journal	Journal of the American Society of Echocardiography
Volume	35
Issue number	1
Early online date	10 Aug 2021
DOIs	https://doi.org/10.1016/j.echo.2021.08.002
Publication status	Published - 1 Jan 2022

Bibliographical note

Funding Information:
Dr. Claeys has received honoraria and consultancy fees from Abbott Vascular. Dr. Swaans has served as a proctor and lecturer for Abbott Vascular, Boston Scientific, Philips Healthcare, and Bioventrix. Dr. Debonnaire has received speaker fees from Abbott Vascular in the context of MitraClip training. Dr. Daemen has received institutional grant and research support from AstraZeneca , Abbott Vascular , Boston Scientific , ACIST Medical , Medtronic , Pie Medical , and ReCor Medical . Dr. Van Mieghem has received research grant support from Abbott Vascular , Boston Scientific , Medtronic , Edwards Lifesciences , Daiichi Sankyo , and PulseCath .

Publisher Copyright:
© 2021 American Society of Echocardiography

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Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral RegurgitationFinal published version, 1 MBLicence: CC BY

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Ooms, J. F., Bouwmeester, S., Debonnaire, P., Nasser, R., Voigt, J. U., Schotborgh, M. A., Geleijnse, M. L., Kardys, I., Spitzer, E., Daemen, J., De Jaegere, P. P., Houthuizen, P., Swaans, M. J., Dubois, C., Claeys, M., Van Der Heyden, J., Tonino, P. A., & Van Mieghem, N. M. (2022). Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation. Journal of the American Society of Echocardiography, 35(1), 105-115.e8. https://doi.org/10.1016/j.echo.2021.08.002

@article{1209dd3041694f96ad8354003928de5a,

title = "Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation",

abstract = "Background: Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). Methods: This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. Results: Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30\% (interquartile range [IQR], 25\%–35\%), 27 mm2, and 107 mL/m2 (IQR, 90–135 mL/m2), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10–0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32\% [IQR, 27\%–39\%] vs 26\% [IQR, 22\%–33\%]; P <.01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95\% CI, 0.28–0.74; P <.01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95\% CI, 0.53–1.63; P =.80). Overall, in 35\% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30\% (n = 66) and 37\% (n = 76), with no differences between dFMR and pFMR. Conclusions: TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders.",

author = "Ooms, \{Joris F.\} and Sjoerd Bouwmeester and Philippe Debonnaire and Riwa Nasser and Voigt, \{Jens Uwe\} and Schotborgh, \{Mark A.\} and Geleijnse, \{Marcel L.\} and Isabella Kardys and Ernest Spitzer and Joost Daemen and \{De Jaegere\}, \{Peter P.\} and Patrick Houthuizen and Swaans, \{Martin J.\} and Christophe Dubois and Marc Claeys and \{Van Der Heyden\}, Jan and Tonino, \{Pim A.\} and \{Van Mieghem\}, \{Nicolas M.\}",

note = "Funding Information: Dr. Claeys has received honoraria and consultancy fees from Abbott Vascular. Dr. Swaans has served as a proctor and lecturer for Abbott Vascular, Boston Scientific, Philips Healthcare, and Bioventrix. Dr. Debonnaire has received speaker fees from Abbott Vascular in the context of MitraClip training. Dr. Daemen has received institutional grant and research support from AstraZeneca , Abbott Vascular , Boston Scientific , ACIST Medical , Medtronic , Pie Medical , and ReCor Medical . Dr. Van Mieghem has received research grant support from Abbott Vascular , Boston Scientific , Medtronic , Edwards Lifesciences , Daiichi Sankyo , and PulseCath . Publisher Copyright: {\textcopyright} 2021 American Society of Echocardiography",

year = "2022",

month = jan,

day = "1",

doi = "10.1016/j.echo.2021.08.002",

language = "English",

volume = "35",

pages = "105--115.e8",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

publisher = "Elsevier Inc.",

number = "1",

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Ooms, JF, Bouwmeester, S, Debonnaire, P, Nasser, R, Voigt, JU, Schotborgh, MA, Geleijnse, ML , Kardys, I, Spitzer, E, Daemen, J , De Jaegere, PP, Houthuizen, P, Swaans, MJ, Dubois, C, Claeys, M, Van Der Heyden, J, Tonino, PA & Van Mieghem, NM 2022, 'Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation', Journal of the American Society of Echocardiography, vol. 35, no. 1, pp. 105-115.e8. https://doi.org/10.1016/j.echo.2021.08.002

TY - JOUR

T1 - Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation

AU - Ooms, Joris F.

AU - Bouwmeester, Sjoerd

AU - Debonnaire, Philippe

AU - Nasser, Riwa

AU - Voigt, Jens Uwe

AU - Schotborgh, Mark A.

AU - Geleijnse, Marcel L.

AU - Kardys, Isabella

AU - Spitzer, Ernest

AU - Daemen, Joost

AU - De Jaegere, Peter P.

AU - Houthuizen, Patrick

AU - Swaans, Martin J.

AU - Dubois, Christophe

AU - Claeys, Marc

AU - Van Der Heyden, Jan

AU - Tonino, Pim A.

AU - Van Mieghem, Nicolas M.

N1 - Funding Information: Dr. Claeys has received honoraria and consultancy fees from Abbott Vascular. Dr. Swaans has served as a proctor and lecturer for Abbott Vascular, Boston Scientific, Philips Healthcare, and Bioventrix. Dr. Debonnaire has received speaker fees from Abbott Vascular in the context of MitraClip training. Dr. Daemen has received institutional grant and research support from AstraZeneca , Abbott Vascular , Boston Scientific , ACIST Medical , Medtronic , Pie Medical , and ReCor Medical . Dr. Van Mieghem has received research grant support from Abbott Vascular , Boston Scientific , Medtronic , Edwards Lifesciences , Daiichi Sankyo , and PulseCath . Publisher Copyright: © 2021 American Society of Echocardiography

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Background: Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). Methods: This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. Results: Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30% (interquartile range [IQR], 25%–35%), 27 mm2, and 107 mL/m2 (IQR, 90–135 mL/m2), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10–0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32% [IQR, 27%–39%] vs 26% [IQR, 22%–33%]; P <.01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95% CI, 0.28–0.74; P <.01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95% CI, 0.53–1.63; P =.80). Overall, in 35% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30% (n = 66) and 37% (n = 76), with no differences between dFMR and pFMR. Conclusions: TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders.

AB - Background: Functional mitral regurgitation (FMR) can be subclassified on the basis of its proportionality relative to left ventricular (LV) volume and function, indicating potential differences in underlying etiology. The aim of this study was to evaluate the association of FMR proportionality with FMR reduction, heart failure hospitalization and mortality after transcatheter edge-to-edge mitral valve repair (TEER). Methods: This multicenter registry included 241 patients with symptomatic heart failure with reduced LV ejection fraction treated with TEER for moderate to severe or greater FMR. FMR proportionality was graded on preprocedural transthoracic echocardiography using the ratio of the effective regurgitant orifice area to LV end-diastolic volume. Baseline characteristics, follow-up transthoracic echocardiography, and 2-year clinical outcomes were compared between groups. Results: Median LV ejection fraction, effective regurgitant orifice area and LV end-diastolic volume index were 30% (interquartile range [IQR], 25%–35%), 27 mm2, and 107 mL/m2 (IQR, 90–135 mL/m2), respectively. Median effective regurgitant orifice area/LV end-diastolic volume ratio was 0.13 (IQR, 0.10–0.18). Proportionate FMR (pFMR) and disproportionate FMR (dFMR) was present in 123 and 118 patients, respectively. Compared with patients with pFMR, those with dFMR had higher baseline LV ejection fractions (median, 32% [IQR, 27%–39%] vs 26% [IQR, 22%–33%]; P <.01). Early FMR reduction with TEER was more pronounced in patients with dFMR (odds ratio, 0.45; 95% CI, 0.28–0.74; P <.01) than those with pFMR, but not at 12 months (odds ratio, 0.93; 95% CI, 0.53–1.63; P =.80). Overall, in 35% of patients with initial FMR reduction after TEER, FMR deteriorated again at 1-year follow-up. Rates of 2-year all-cause mortality and heart failure hospitalization were 30% (n = 66) and 37% (n = 76), with no differences between dFMR and pFMR. Conclusions: TEER resulted in more pronounced early FMR reduction in patients with dFMR compared with those with pFMR. Yet after initial improvement, FMR deteriorated in a substantial number of patients, calling into question durable mitral regurgitation reductions with TEER in selected patients. The proportionality framework may not identify durable TEER responders.

UR - https://www.scopus.com/pages/publications/85113858495

U2 - 10.1016/j.echo.2021.08.002

DO - 10.1016/j.echo.2021.08.002

M3 - Article

C2 - 34389469

AN - SCOPUS:85113858495

SN - 0894-7317

VL - 35

SP - 105-115.e8

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

IS - 1

ER -

Transcatheter Edge-to-Edge Repair in Proportionate Versus Disproportionate Functional Mitral Regurgitation

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