title: Early results of MitraClip system implantation by real-time three-dimensional speckle-tracking left ventricle analysis.
abstract: OBJECTIVE
  To appraise the early effect of percutaneous mitral valve repair with the MitraClip system on myocardial function using real-time three-dimensional speckle-tracking echocardiography (3D-STE).
  
  
  METHODS
  Consecutive patients with moderate-to-severe or severe mitral regurgitation, undergoing mitral valve repair with the MitraClip system, were prospectively evaluated during the peri-procedural workout and follow-up. Left ventricular deformation was evaluated by a two-dimensional and 3D speckle-tracking analysis. 3D-STE acquisitions were elaborated obtaining real-time 3D global longitudinal strain evaluation, and by appraising both volumetric and hemodynamic parameters (i.e. left ventricular end-diastolic volume, left ventricular end-systolic volume, left ventricular ejection fraction, cardiac output, and stroke volume).
  
  
  RESULTS
  In all, 30 patients were included. At 1-month follow-up, 3D-STE analysis revealed no changes in left ventricular end-diastolic volume (162.6 ± 73.7 ml at baseline vs. 159.8 ± 64.5 ml at 1-month follow-up; P = 0.63) and a downward trend in left ventricular end-systolic volume (104.7 ± 52.0 vs. 100.1 ± 50.4 ml, respectively; P = 0.06). Left ventricular ejection fraction did not significantly increase (38.1 ± 11.3% at baseline vs. 39.4 ± 11.0% at 1-month follow-up; P = 0.20). No significant changes were reported in cardiac output (4.3 ± 2.0 l/min at baseline vs. 4.0 ± 1.5 l/min at follow-up; P = 0.377) and in stroke volume (59.5 ± 25.5 ml at baseline vs. 59.9 ± 20.7 ml at follow-up; P = 0.867). On the contrary, left ventricular deformation capability significantly improved, with the real-time 3D global longitudinal strain value changing from -9.8 ± 4.1% at baseline to -11.0 ± 4.4% at follow-up (P = 0.018).
  
  
  CONCLUSIONS
  Accurately assessing myocardial function by the use of 3D-STE, this study reported irrelevant early changes in left ventricular size, but a positive effect on left ventricular deformation capability following mitral valve repair with the MitraClip system. These preliminary results need to be confirmed in larger series and extended to long-term follow-up.
authors.affiliation: aCardiovascular Department, Ferrarotto Hospital, University of Catania bExcellence Through Newest Advances (ETNA) Foundation, Catania, Italy *Salvatore Scandura and Fabio Dipasqua contributed equally to the writing of this article.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scandura
authors.forename: Fabio
authors.initials: F
authors.lastname: Dipasqua
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Anna
authors.initials: A
authors.lastname: Caggegi
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
authors.forename: Sarah
authors.initials: S
authors.lastname: Mangiafico
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Pistritto
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immè
authors.forename: Marta
authors.initials: M
authors.lastname: Chiarandà
authors.forename: Margherita
authors.initials: M
authors.lastname: Ministeri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ronsivalle
authors.forename: Stefano
authors.initials: S
authors.lastname: Cannata
authors.forename: Antonio Andrea
authors.initials: AA
authors.lastname: Arcidiacono
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013318:Stroke Volume; D053831:Surgical Fixation Devices / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016277:Ventricular Function, Left