title: Quantitative assessment of severity of mitral regurgitation by serial echocardiography in a multicenter clinical trial of percutaneous mitral valve repair.
abstract: 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 > or =6 months.
authors.affiliation: Department of Cardiology, University of California, San Francisco, California, USA. foster@medicine.ucsf.edu
authors.forename: Elyse
authors.initials: E
authors.lastname: Foster
authors.forename: Hal S
authors.initials: HS
authors.lastname: Wasserman
authors.forename: William
authors.initials: W
authors.lastname: Gray
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rodriguez
authors.forename: William J
authors.initials: WJ
authors.lastname: Stewart
authors.forename: Patrick
authors.initials: P
authors.lastname: Whitlow
authors.forename: Peter
authors.initials: P
authors.lastname: Block
authors.forename: Randy
authors.initials: R
authors.lastname: Martin
authors.forename: John
authors.initials: J
authors.lastname: Merlino
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: Frank E
authors.initials: FE
authors.lastname: Silvestry
authors.forename: Andrew
authors.initials: A
authors.lastname: Hamilton
authors.forename: Alan
authors.initials: A
authors.lastname: Zunamon
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kraybill
authors.forename: Ivor L
authors.initials: IL
authors.lastname: Gerber
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Weeks
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
mesh_terms: D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D012039:Regional Blood Flow; D012720:Severity of Illness Index