title: Immediate increase of cardiac output after percutaneous mitral valve repair (PMVR) determined by echocardiographic and invasive parameters: Patzelt: Increase of cardiac output after PMVR.
abstract: BACKGROUND
  Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography.
  
  
  METHODS
  101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe).
  
  
  RESULTS
  All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p<0.001). Furthermore, pulmonary artery systolic pressure (PASP) showed a significant decrease after PMVR (47.6±16.1 before, 44.7±15.5mmHg after, p=0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p=0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots.
  
  
  CONCLUSIONS
  CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Patzelt
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China.
authors.forename: Yingying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Harry
authors.initials: H
authors.lastname: Magunia
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Rezo
authors.initials: R
authors.lastname: Jorbenadze
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Droppa
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Ulrich
authors.affiliation: University Hospital, Department of Cardiology, Qingdao University, 266003 Qingdao, China.
authors.forename: Shanglang
authors.initials: S
authors.lastname: Cai
authors.affiliation: University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Lausberg
authors.affiliation: University Hospital, Department of Cardiovascular Surgery, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Walker
authors.affiliation: Department of Cardiology and Angiology, Heart Center Freiburg University, 79106 Freiburg im Breisgau, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wengenmayer
authors.affiliation: University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rosenberger
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Schreieck
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Seizer
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany.
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.affiliation: University Hospital, Department of Cardiology and Cardiovascular Medicine, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany. Electronic address: harald.langer@med.uni-tuebingen.de.
authors.forename: Harald F
authors.initials: HF
authors.lastname: Langer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D016037:Single-Blind Method
keywords: Cardiac output; Echocardiography; Hemodynamics; Mitral regurgitation; Percutaneous mitral valve repair