title: Assessment of acute changes in ventricular volumes, function, and strain after interventional edge-to-edge repair of mitral regurgitation using cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  Whereas haemodynamic and echocardiographic studies suggest benefits for left ventricular (LV) function and cardiac output following reduction in LV preload by interventional edge-to-edge repair for mitral regurgitation (MR), there is limited data on volumetric and functional LV and right ventricular (RV) changes using cardiac magnetic resonance (CMR) imaging.
  
  
  RESULTS
  Patients with moderate to severe MR and high surgical risk underwent MitraClip-implantation and CMR imaging before and within 7 days after the procedure. In addition to volumetric and flow studies, myocardial feature tracking (FT) technology for quantification of myocardial strain was applied. Twenty patients (age: 76 ± 8 years) with functional (n = 15) or degenerative MR (n = 5) with a mean logistic Euroscore I of 33 ± 16 underwent both successful MitraClip implantation and CMR imaging. MR fraction (36 ± 10 vs. 19 ± 12%; P < 0.001) and LV end-diastolic volume (115 ± 36 vs. 105 ± 41 mL/m2; P = 0.002) decreased significantly, whereas LV ejection fraction (42 ± 15 vs. 41 ± 16%, P = 0.8) and cardiac index (1.7 ± 0.5 vs. 1.8 ± 0.4 L/min/m2, P = 0.4) remained unchanged. MitraClip implantation resulted in a significant impairment of circumferential (-12.8 ± 4.8 vs. -8.2 ± 3.3; P = 0.002) and radial strain (15.4 ± 7.7 vs. 9.6 ± 5.3; P = 0.02) on basal short-axis view. On RV level, there were no significant changes in end-diastolic volume (83 ± 19 vs. 84 ± 18 mL/m2, P = 0.8), ejection fraction (42 ± 9 vs. 43 ± 11%, P = 0.8), or tricuspid regurgitation fraction (24 ± 17 vs. 25 ± 19%, P = 0.7). MitraClip implantation led to a significant improvement in New York Heart Association functional class (patients in functional class III-IV pre 100% vs. post 45%; P < 0.001).
  
  
  CONCLUSIONS
  In severely compromised patients, marked reduction in MR by MitraClip implantation might not result in immediate improved cardiac output and effective biventricular forward flow.
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany Philipp.Lurz@gmx.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Lurz
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
authors.forename: Rokas
authors.initials: R
authors.lastname: Serpytis
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Blazek
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany.
authors.forename: Norman
authors.initials: N
authors.lastname: Mangner
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Noack
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Ender
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.affiliation: Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Gutberlet
authors.affiliation: University Heart Center Luebeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University of Luebeck, Luebeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000175:diagnosis* / Q000209:etiology*
keywords: Magnetic resonance imaging; MitraClip; Mitral insufficiency; Strain imaging