title: Impact of mitral geometry and global afterload on improvement of mitral regurgitation after trans-catheter aortic valve implantation.
abstract: OBJECTIVE
  To assess the impact of mitral geometry, left ventricular (LV) remodelling and global LV afterload on mitral regurgitation (MR) after trans-catheter aortic valve implantation (TAVI).
  
  
  METHODS
  In this study, 60 patients who underwent TAVI were evaluated by 3D echocardiography at baseline, 1 month and 6 months after procedure. The proportional change in MR following TAVI was determined by examining the percentage change in vena contracta (VC) at 6 months. Patients having a significant reduction of at least 30% in VC were defined as good responders (GR) and the remaining patients were defined as poor responders (PR).
  
  
  RESULTS
  After 6 months of TAVI, 27 (45%) patients were GR and 33 (55%) were PR. There was a significant decrease in 3DE-derived mitral annular diameter and area (P = 0.001), mitral valve tenting area (TA) (P = 0.05), and mitral papillary muscle dyssynchrony index (DSI) (P = 0.05) in the GR group. 3DE-derived LVESV (P = 0.016), LV mass (P = 0.001) and LV DSI, (P = 0.001) were also improved 6 months after TAVI. In addition, valvulo-arterial impedance (ZVA) was significantly higher at baseline in patients with PR (P = 0.028). 3DE-derived mitral annular area (β: 0.47, P = 0.04), mitral papillary DSI (β: -0.65, P = 0.012) and ZVA (β: 0.45, P = 0.028) were the strongest independent parameters that could predict the reduction of functional MR after TAVI.
  
  
  CONCLUSIONS
  GR patients demonstrate more regression in mitral annulus area and diameter after significant decrease in high LVEDP and trans-aortic gradients with TAVI. PR patients appear to have increased baseline ZVA, mitral valve tenting and restriction in mitral valve coaptation. These factors are important for predicting the impact of TAVI on pre-existing MR.
authors.affiliation: Cardiology Division, Liv Hospital Ulus, Istanbul, Turkey ytayyareci@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Tayyareci
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Dworakowski
authors.affiliation: Department of Internal Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: P
authors.initials: P
authors.lastname: Kogoj
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Reiken
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Kenny
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: MacCarthy
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Wendler
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Monaghan
keywords: TAVI; mitral regurgitation; mitral valve geometry; valvulo-arterial incompetence