title: Three-Dimensional Transthoracic Echocardiography in the Comprehensive Evaluation of Right and Left Heart Chamber Remodeling Following Percutaneous Mitral Valve Repair.
abstract: Percutaneous mitral valve repair (PMVR) is an alternative treatment in patients with significant mitral regurgitation (MR) who are denied surgery. Although in surgical patients, outcomes have been related both to acute hemodynamic favorable results and to positive cardiac remodeling in the midterm, in the case of PMVR the effect on cardiac chamber remodeling has never been extensively studied. The aims of this study were (1) to evaluate the short- and mid-term remodeling induced by PMVR on cardiac chamber volume using two- and three-dimensional (3D) transthoracic echocardiographic (TTE) imaging and (2) to assess changes in left ventricular (LV) shape on the basis of 3D TTE data.
  
  
  
  Patients undergoing PMVR were prospectively enrolled. Two-dimensional and 3D TTE data sets acquired at baseline, and at 30 days and 6 months after PMVR were analyzed to assess LV and right ventricular (RV) volumes and ejection fraction and left atrial and right atrial volumes. Moreover, 3D endocardial surfaces were extracted to compute 3D shape indexes of LV sphericity and conicity at end-diastole and end-systole.
  
  
  
  Six of the 64 enrolled patients did not reach follow-up and were excluded. The analysis was feasible in all 58 patients considered (26 with functional MR and 32 [55%] with degenerative MR). PMVR resulted in significant reduction of MR and in favorable remodeling: (1) effective PMVR was mainly associated with decreased LV loading, (2) PMVR-related reverse remodeling was observed in patients with degenerative MR and those with functional MR at 30 days and continued at 6-month follow-up, (3) favorable remodeling in LV shape from abnormally spherical to more normal conical took place in both groups after PMVR, and (4) RV volumes and systolic function were preserved after PMVR.
  
  
  
  A comprehensive two-dimensional and 3D TTE analysis allows investigation from a double perspective (volume and morphology) of the entity and modality of changes following PMVR. In high-risk patients undergoing PMVR, postprocedural heart remodeling involves all cardiac chambers, occurs in the short term, and further improves at midterm follow-up.
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy. Electronic address: paola.gripari@ccfm.it.
authors: Paola
authors: P
authors: Gripari
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Gloria
authors: G
authors: Tamborini
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Vera
authors: V
authors: Bottari
authors: Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois; Center for Computational Medicine in Cardiology, Institute of Computational Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
authors: Francesco
authors: F
authors: Maffessanti
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Maria Chiara
authors: MC
authors: Carminati
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Manuela
authors: M
authors: Muratori
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Carlo
authors: C
authors: Vignati
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors: Antonio L
authors: AL
authors: Bartorelli
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors: Francesco
authors: F
authors: Alamanni
authors: Centro Cardiologico Monzino IRCCS, Milan, Italy.
authors: Mauro
authors: M
authors: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D020257:Ventricular Remodeling
keywords: 3D echocardiography; Cardiac remodeling; Percutaneous mitral valve repair