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Early results of MitraClip system implantation by real-time three-dimensional speckle-tracking left ventricle analysis

Scandura, Salvatore; Dipasqua, Fabio; Gargiulo, Giuseppe; Capodanno, Davide; Caggegi, Anna; Grasso, Carmelo; Mangiafico, Sarah; Pistritto, Anna Maria; Immè, Sebastiano; Chiarandà, Marta; Ministeri, Margherita; Ronsivalle, Giuseppe; Cannata, Stefano; Arcidiacono, Antonio Andrea; Capranzano, Piera; Tamburino, Corrado

Journal of Cardiovascular Medicine: November 2016 - Volume 17 - Issue 11 - p 843–849
doi: 10.2459/JCM.0000000000000284
Interventional cardiology
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Aims 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.

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.

Correspondence to Davide Capodanno, MD, Cardiology Department, Ferrarotto Hospital, University of Catania, Via Citelli 6, 95124 Catania, ItalyTel: +39 0957436202; fax: +39 095362429; e-mail: dcapodanno@gmail.com

Received 24 July, 2014

Revised 3 February, 2015

Accepted 18 March, 2015

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© 2016 Italian Federation of Cardiology. All rights reserved.