title: Assessment of Biventricular Function by Three-Dimensional Speckle-Tracking Echocardiography in Secondary Mitral Regurgitation after Repair with the MitraClip System.
abstract: BACKGROUND
  The goal of this study was to determine changes in left ventricular (LV) and right ventricular (RV) function with three-dimensional (3D) speckle-tracking echocardiography (STE) after percutaneous mitral valve repair with the MitraClip system in high-risk surgical patients with moderate to severe or severe secondary mitral regurgitation (MR).
  
  
  METHODS
  Thirty-two patients with MR undergoing MitraClip were prospectively included. Patients underwent two-dimensional (2D) and 3D transthoracic echocardiography before clip implantation and after 6-month follow-up. LV and RV longitudinal strain was obtained by 2D STE and 3D STE. LV circumferential, radial, and area strain was calculated by 3D STE. Data analysis was performed offline.
  
  
  RESULTS
  At 6-month follow-up, significant improvements were seen in LV 2D global longitudinal strain (P < .005), 3D global longitudinal strain (P = .0002), and 3D area strain (P = .0001). Overall, significant improvements were also seen in 3D RV ejection fraction (P < .05) and 3D RV free-wall longitudinal strain (P < .05). A poor increase in LV strain after clip implantation (P = NS) occurred in patients with pronounced preexisting RV dysfunction. The areas under the receiver operating characteristic curves for LV and RV 3D speckle-tracking echocardiographic parameters showed high discriminative values (range, 0.87-0.91) in predicting unfavorable outcomes with persistent symptoms (New York Heart Association class > II) after the procedure.
  
  
  CONCLUSIONS
  Three-dimensional STE showed overall LV and RV strain improvement after clip implantation as well as lower postprocedural LV strain values in patients with worse preexisting RV function. These findings could help in guiding MR treatment strategies, suggesting different therapies in the presence of marked RV impairment or anticipating the procedure in case of evolving RV dysfunction.
authors.affiliation: Sapienza University, Rome, Italy. Electronic address: vitar@tiscali.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Vitarelli
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Mangieri
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Capotosto
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Tanzilli
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: D'Angeli
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Viceconte
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Placanica
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Placanica
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Nino
authors.initials: N
authors.lastname: Cocco
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Rasul
authors.initials: R
authors.lastname: Ashurov
authors.affiliation: Sapienza University, Rome, Italy.
authors.forename: Suliman
authors.initials: S
authors.lastname: Al-Kindy
mesh_terms: D000368:Aged; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D011474:Prosthesis Design; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Echocardiography; Left ventricular function; MitraClip system; Mitral regurgitation; Right ventricular function; Speckle-tracking imaging