• Benedikt Schrage, Daniel Kalbacher, Michael Schwarzl, Nicole Rübsamen, Christoph Waldeyer, Becher Peter Moritz PM Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany., Eike Tigges, Daniel Burkhoff, Stefan Blankenberg, Edith Lubos, Ulrich Schäfer, and Dirk Westermann.
• Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
• J Am Heart Assoc. 2018 Mar 15; 7 (6).

BackgroundPercutaneous mitral valve edge-to-edge repair (pMVR) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction (EF). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure-volume loops to investigate the left ventricular (LV) remodeling of patients after pMVR dependent on their baseline EF.Methods And ResultsIn 130 patients with successful pMVR, the end-diastolic pressure-volume relationship (EDPVR) and end-systolic pressure-volume relationship were estimated noninvasively from echocardiographic data. We compared EDPVR and end-systolic pressure-volume relationship at discharge and follow-up between patients with a reduced EF (<40%) and patients with a mid-ranged or preserved EF (≥40%). Reduced EF was present in 71 patients (54%). Mean follow-up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow-up irrespective of baseline EF. In patients with a mid-ranged or preserved EF, the EDPVR and end-systolic pressure-volume relationship were shifted leftwards, suggesting an improvement in LV function. In contrast, in patients with a reduced EF, EDPVR and end-systolic pressure-volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the EDPVR. This indicates that there is no improvement in LV function after pMVR in patients with reduced EF.ConclusionsThe pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid-ranged or preserved EF, we found reverse remodeling with reduced LV dilatation and increased contractility. In contrast, in patients with reduced EF, we observed no reverse remodeling and no improvement in LV function.© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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