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  • Ovid Technologies (Wolters Kluwer Health)  (3)
  • Salaun, Erwan  (3)
  • 1
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    Online Resource
    Abstract 11879: Von Willebrand Factor Activity and Closure Time With Adenosine Diphosphate During Transcatheter Mitral Valve Repair
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Residual mitral regurgitation (MR) is associated with worse outcomes after transcatheter edge to edge mitral valve repair (TEER) but is difficult to assess by echocardiography. Shear-stress induced by MR leads to altered Von Willebrand factor activity (vWF:Act), also reflected by increased closure time with adenosine diphosphate (CT-ADP), representing potential ways to screen for residual MR. CT-ADP can be assessed easily during TEER and is known to normalize swiftly after the correction of turbulent flow. Hypothesis: The improvement of CT-ADP is quick enough to allow real-time procedural guidance. Methods: We enrolled 39 patients undergoing TEER. MR severity was assessed by echocardiography during the procedure, 24-hours and 1-month post-TEER. CT-ADP was measured before TEER, 8 minutes after each clip deployment, 1 hour and 24 hours after the procedure. CT-ADP values were related with vWF:Act and MR severity at each time point. Results: Of 39 patients after TEER, 6 (15%) and 8 (21%) patients had residual MR ≥ moderate at 24-hours and 1-month respectively. There was no significant change in CT-ADP values during the procedure. The decrease of CT-ADP was however significant 1-hour post-TEER with stable values at 24-hours (last clip deployment: 136 [110-193]; 1 hour: 99 [82-131] and 24 hours: 95 [82-121] seconds, p 〈 0.001). Concomitant increase in vWF:Act was observed after the procedure (baseline: 1.76 [1.29-2.05]; 1 hour: 1.84 [1.79-1.85] and 24 hours: 2.32 [1.84-2.5] IU/ml, p=0.002). Patients were stratified into 3 groups according to the residual MR grade at 1 month (≤ mild vs. moderate vs. 〉 moderate). CT-ADP was not different among the groups (p=0.74). However, the difference in CT-ADP (1 month vs baseline values) was associated with MR improvement at the same time points (r=0.50; p=0.007). Conclusions: Although CT-ADP decreases after TEER and correlates with vWF:Act and MR improvement at 1 month, this decrease is first observed 1 hour after the procedure and does not seem to be quick enough to provide real-time monitoring of MR severity during TEER.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.11879
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 2
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    Online Resource
    Abstract 13429: Echocardiographic Predictors of Mitral Transvalvular Gradients After Mitraclip Insertion
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 142, No. Suppl_3 ( 2020-11-17)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 142, No. Suppl_3 ( 2020-11-17)
    Abstract: Introduction: The MitraClip procedure is a non-surgical alternative for patients with severe mitral regurgitation and high surgical risk. However, the MitraClip may lead to a reduction in the mitral valve orifice area (MVOA) and elevated transmitral mean gradients (TMG). The objectives of this study are to assess the value of baseline MVOA by different imaging methods and explore the value of MVOA indexed for left ventricular (LV) forward stroke volume (SV) to predict postprocedural TMG. Methods: Preprocedural echo images were retrospectively reviewed in 76 consecutive patients. MVOA from 2D transthoracic (MVOA TTE ), 2D transgastric (MVOA TG ) and 3D transesophageal (MVOA 3D ) echocardiography were measured and then indexed by the SV measured by Doppler in the LV outflow tract (MVOA/SV) . Postprocedural TMG was measured at one month and survival rate at one year. Results: Patients with postprocedural TMG 〉 5 mmHg (18/76, 24%) had significantly smaller preprocedural MVOA 3D (3.9±0.9 vs 5.2±1.3 cm 2 , p 〈 0.01) and MVOA TTE (4.9±1.1 vs 5.9±1.5 cm 2 , p=0.02). No significant difference was found for MVOA TG (5.5±1.4 vs 5.9±1.4 cm 2 , p=0.2). Best threshold values for MVOA 3D and MVOA TTE to predict postprocedural TMG 〉 5 mmHg were respectively 3.9 cm 2 (AUC=0.80, IC95%: 0.67-0.94, p 〈 0.01; sensitivity (Se) 62%, specificity (Sp) 87%) and 4,6 cm 2 (AUC=0.69, IC95%: 0.54-0.83, p=0.02; Se 50%, Sp 84%). MVOA/SV from each echocardiographic modality were smaller in patients with postprocedural TMG 〉 5 mmHg (3D: 80 [62-95] vs 113 [99-129] cm 2 /L; TTE: 92 [81-105] vs 130 [100-166] cm 2 /L; TG: 104 [83-123] vs 135 [104-166] cm 2 /L; p 〈 0.01 for all). MVOA/SV 3D was overall the best predictor of postprocedural TMG 〉 5 mmHg, with an optimal threshold of 96 cm 2 /L (AUC=0.86, IC95%: 0.76-0.97, p 〈 0.001; Se 84%, Sp 81%). Patients with MVOA 3D 〈 3.9 cm 2 and MVOA/SV 3D 〈 96 cm 2 /L tend to be at higher risk for mortality at one-year follow-up (69% vs 84%, p=0.14 and 67% vs 87%, p=0.11 respectively). Conclusion: Unlike preprocedural MVOAs assessed by 3D echocardiography, preprocedural MVOAs measured by 2D echocardiographic modalities were poor predictors of high TMG after MitraClip. Preprocedural MVOA 3D 〈 3.9 cm 2 and MVOA/SV 3D 〈 96 cm 2 /L were found to be the best cut-off values to predict postprocedural TMG 〉 5 mmHg.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.142.suppl_3.13429
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 3
    Online Resource
    Online Resource
    Abstract 10566: Echocardiographic Predictors of Successful Transcatheter Mitral Valve Repair with the Mitraclip System
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Residual mitral regurgitation (rMR) and elevated transmitral gradients (TMG) are associated with worse outcomes after percutaneous mitral repair. This study aims to assess if pre-intervention MR jet width and its relation to the mitral commissural length (MCL) are able to predict post-procedure rMR and TMG. Methods: Preprocedural echocardiographic images were retrospectively reviewed in 74 patients who underwent an edge-to-edge repair (2014-2018). Maximal MR jet width and MCL were measured from a bi-commissural view. Complete follow-up echocardiographic examination was performed at 1-3 months. Left ventricle (LV) and left atrial (LA) severe dilation were defined as LV end-diastolic diameter ≥6.5 cm and LA indexed volume ≥48 ml/m 2 . Presence of rMR ≥moderate, combination of rMR and TMG 〉 5 mmHg (rMR+TMG), and all-cause mortality within 1-year follow-up were examined. Results: Of 74 patients, 25 (34%) had rMR [17/25 moderate and 8/25 severe)] and 39 (53%) had either rMR or elevated TMG. Both MR jet width and its ratio with MCL were good predictors for the implantation of 〉 2 clips (p 〈 0.01 for both). Patients with rMR had a significantly larger pre-procedural jet width versus those without MR (1.63±0.54 cm vs 1.29±0.53 cm; p=0.01); without significant difference for the ratio of jet width/MCL (p=0.07). However, this ratio was higher in patients having rMR+TMG (41.05±13.15 % vs 34.26±12.64 %; p=0.03). In univariate analysis, MR jet width was a good predictor of rMR (OR: 3.35, 95%CI: 1.09-10.48; p=0.03) and severe post-intervention LV (OR: 6.43, 95%CI: 1.35-45.01; p=0.03) and LA dilation (OR: 3.02, 95%CI: 1.16-8.69; p=0.03); whereas the ratio was a good predictor of rMR+TMG (OR: 1.69, 95%CI: 1.12-2.70; p=0.02). Patients with rMR and rMR+TMG tended to be at higher risk of mortality at one year, without reaching statistical significance in this small population (24% vs 14%, p=0.17 and 23% vs 11%, p=0.14 respectively). Conclusion: MR jet width and its ratio with MCL are respectively associated to rMR or combined rMR+TMG after percutaneous mitral repair. MR jet width was also useful to identify patients who remained with severe LV and LA dilatation post-intervention.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.10566
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
    Location Call Number Limitation Availability
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