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10 Primary mitral regurgitation successfully treated by percutaneous mitral valve leaflet repair results in positive cardiac reverse remodelling and functional improvement
  1. Thomas Craven1,
  2. Pei Gee Chew1,
  3. Miroslawa Gorecka1,
  4. Louise Brown1,
  5. Arka Das1,
  6. Amrit Chowdhary1,
  7. Nicholas Jex1,
  8. Sharmaine Thirunavukarasu1,
  9. Erica Dall’Armellina1,
  10. Eylem Levelt2,
  11. Dominik Schlosshan3,
  12. Christopher Malkin3,
  13. Daniel Blackman3,
  14. Sven Plein1,
  15. John Greenwood1
  1. 1University of Leeds, Leeds, UK
  2. 2University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science
  3. 3Leeds Teaching Hospitals NHS trust


Background Percutaneous mitral valve leaflet repair can be an effective treatment for primary mitral regurgitation (MR) patients deemed high-risk for surgery. Accurate assessment of cardiac reverse remodelling is essential to optimise future patient selection. Cardiovascular magnetic resonance (CMR) is the reference standard for cardiac volumetric assessment and compared to transthoracic echocardiography (TTE) provides superior reproducibility in MR quantification. Prior CMR studies have analysed cardiac reverse remodelling following percutaneous intervention in combined cohorts of primary and secondary MR patients. However, as aetiology of MR can significantly impact outcomes, focused studies are warranted. Therefore, we aimed to assess cardiac reverse remodelling and quantify changes in MR following percutaneous mitral valve leaflet repair for primary MR using the reference standard (CMR).

Methods 12 patients with at least moderate-severe MR on TTE were prospectively recruited to undergo CMR imaging and 6-minute walk tests (6MWT) at baseline and 6 months following percutaneous mitral valve leaflet repair (MitraClip). CMR protocol involved: left-ventricular (LV) short axis cines (bSSFP, SENSE-2, 10mm, no gap), transaxial right-ventricular (RV) cines (bSSFP, SENSE-2, 8mm, no gap), two and four chamber cines and aortic through-plane phase contrast imaging, planned at the sino-tubular junction. MR was quantified indirectly using LV and aortic stroke volumes.

Results 12 patients underwent percutaneous mitral valve leaflet repair (MitraClip) for posterior mitral valve leaflet prolapse, however 1 patient declined follow up after single-leaflet clip detachment resulting in 11 patients (age 83±5years, 9 male) completing follow up imaging. At 6-months: significant improvements occurred in New York Heart Association functional class and 6MWT distances (223±71m to 281±65m, p=0.005) (table 1) and significant reductions occurred in indexed left ventricular end-diastolic volumes (LVEDVi) (118±21ml/m2 to 94±27ml/m2, p=0.001), indexed left ventricular end-systolic volumes (58±19ml/m2 to 48±21ml/m2, p=0.007) and quantitated MR volume (55±22ml to 24±12ml, p=0.003) and MR fraction (49±9.4% to 29±14%, p≤0.001) (table 2). There were no statistically significant changes in left ventricular ejection fraction (LVEF), right ventricular dimensions/ejection fraction or bi-atrial dimensions (table 2). All patients demonstrated decreased LVEDVi and quantified MR (figure 1).

Abstract 10 Figure 1

Reduction in indexed left ventricular (LV) end-diastolic volumes and mitral regurgitation 6-months after percutaneous mitral valve leaflet repairDashed black line represents mean values

Abstract 10 Table 1

Functional changes6-months following percutaneous mitral valve leaflet repair

Abstract 10 Table 2

Changes incardiac indices 6-months following percutaneous mitral valve leaflet repair

Conclusion Successful percutaneous mitral valve leaflet repair for primary MR results in reduction in MR, positive LV reverse remodelling, preservation of LVEF, and functional improvements. Larger CMR studies are now required to further guide optimal patient selection.

Conflict of Interest Nil

  • Mitral Regurgitation
  • MitraClip
  • Cardiovascular Magnetic Resonance

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