Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair

被引:176
作者
Foster, Elyse [1 ]
Wasserman, Hal S.
Gray, William
Homma, Shunichi
Di Tullio, Marco R.
Rodriguez, Leonardo
Stewart, William J.
Whitlow, Patrick
Block, Peter
Martin, Randy
Merlino, John
Herrmann, Howard C.
Wiegers, Susan E.
Silvestry, Frank E.
Hamilton, Andrew
Zunamon, Alan
Kraybill, Kimberly
Gerber, Ivor L.
Weeks, Sarah G.
Zhang, Yan
Feldman, Ted
机构
[1] Univ Calif San Francisco, Dept Cardiol, San Francisco, CA 94143 USA
[2] Columbia Univ, New York, NY USA
[3] Cleveland Clin, Cleveland, OH 44106 USA
[4] Emory Univ, Atlanta, GA 30322 USA
[5] Univ Penn, Philadelphia, PA 19104 USA
[6] Northwestern Univ, Evanston Hosp, Evanston, IL 60201 USA
[7] Swedish Med Ctr, Seattle, WA USA
[8] Auckland City Hosp, Auckland, New Zealand
关键词
D O I
10.1016/j.amjcard.2007.06.066
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aims of the echocardiographic substudy of this multicenter trial were to evaluate the use of quantitative assessment of mitral regurgitation (MR) severity using serial echocardiography and to assess the efficacy of percutaneous mitral valve repair. Previous surgical repair studies did not use quantitative echocardiographic methods. Results of a percutaneous mitral valve repair clip device in a core echocardiographic laboratory were evaluated. Published parameters for quantifying MR were used in a systematic protocol to qualify patients for study entry and evaluate treatment efficacy at discharge and 6 months after clip repair. Baseline results were presented for 55 patients, and follow-up results, for 49. Ninety-eight percent of required echocardiographic studies were submitted to the core laboratory, and > 85% of required measurements were possible. At baseline, mean regurgitant volume was 54.8 +/- 24 ml, regurgitant fraction was 46.9 +/- 16.2%, effective regurgitant orifice area was 0.71 +/- 0.40 cm(2), and vena contracta width was 0.66 +/- 0.20 cm. Based on a severity scale of 1 to 4, mean color flow grade was 3.4 +/- 0.7, and mean pulmonary vein flow was 2.8 +/- 1.2. In patients with a clip at 6 months, all measurements of MR severity were significantly decreased versus baseline, with mean regurgitant volume decreased from 50.3 to 27.5 ml (change -22.8 ml; p < 0.0001), regurgitant fraction from 44.6% to 28.9% (change -15.7%; p < 0.0001), color flow grade from an average of 3.4 to 1.8 (change -1.6; p < 0.0001), and pulmonary vein flow from 2.8 to 1.8 (change -1.0; p < 0.0018). In conclusion, quantitative assessment of MR is feasible in a multicenter trial, and percutaneous mitral repair with the MitraClip produces a sustained decrease in MR severity to moderate or less for >= 6 months. (c) 2007 Elsevier Inc. All rights reserved.
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收藏
页码:1577 / 1583
页数:7
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