Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging

Abstract

Purpose: Percutaneous mitral valve repair with the MitraClip device (Abbott Vascular, Redwood City, California, USA) is a novel therapeutic option in patients with mitral regurgitation. This study evaluated the feasibility of cardiac volume measurements by cardiovascular magnetic resonance imaging (CMR) to assess reverse myocardial remodeling in patients after MitraClip implantation.

Materials and Methods: 12 patients underwent CMR at baseline (BL) before and at 6 months follow-up (FU) after MitraClip implantation. Cine-CMR was performed in short- and long-axes for the assessment of left ventricular (LV), right ventricular (RV) and left atrial (LA) volumes.

Results: Assessment of endocardial contours was not compromised by the device-related artifact. No significant differences in observer variances were observed for LV, RV and LA volume measurements between BL and FU. LV end-diastolic (median 127 [IQR 96 – 150] vs. 112 [86 – 150] ml/m²; p = 0.03) and LV end-systolic (82 [54 – 91] vs. 69 [48 – 99] ml/m²; p = 0.03) volume indices decreased significantly from BL to FU. No significant differences were found for RV end-diastolic (94 [75 – 103] vs. 99 [77 – 123] ml/m²; p = 0.91), RV end-systolic (48 [42 – 80] vs. 51 [40 – 81] ml/m²; p = 0.48), and LA (87 [55 – 124] vs. 92 [48 – 137] ml/m²; p = 0.20) volume indices between BL and FU.

Conclusion: CMR enables the assessment of cardiac volumes in patients after MitraClip implantation. Our CMR findings indicate that percutaneous mitral valve repair results in reverse LV but not in RV or LA remodeling.

Key points:

• Volume measurements by cardiovascular magnetic resonance imaging are feasible following percutaneous mitral valve repair despite device-related artifacts.

• A significant reduction of left ventricular volume was found in terms of beneficial, reverse left ventricular remodeling after 6-month follow-up.

• No significant reduction was found in right ventricular or left atrial volumes after percutaneous mitral valve repair after 6-month follow-up.

Citation Format:

• Radunski UK, Franzen O, Barmeyer A et al. Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging. Fortschr Röntgenstr 2014; 186: 951 – 958

Zusammenfassung

Ziel: Die perkutane Mitralklappenrekonstruktion mittels MitraClip (Abbott Vascular, Redwood City, Kalifornien, USA) stellt ein neues therapeutisches Verfahren dar bei Patienten mit Mitralklappeninsuffizienz. In dieser Studie wurde die Machbarkeit der Volumetrie mittels kardialer Magnetresonanztomografie (MRT) zur Beurteilung eines kardialen Remodelings bei Patienten nach MitraClip-Implantation untersucht.

Material und Methoden: Zwölf Patienten wurden vor sowie sechs Monate nach MitraClip-Implantation mittels kardialer MRT untersucht. Zur Beurteilung von linksventrikulärem (LV), rechtsventrikulärem (RV) und linksatrialem (LA) Volumen wurden Cine-MRT-Sequenzen in Kurzachsenschichten und Langachsenschichten durchgeführt.

Ergebnisse: Durch die perkutane Mitralklappenrekonstruktion bedingte Artefakte schränkten die Abgrenzbarkeit der endokardialen Konturen nicht ein. Es zeigten sich keine signifikanten Unterschiede in den Untersucherabweichungen der Messungen von LV-, RV- und LA-Volumen vor und nach MitraClip-Implantation. Hinsichtlich der Indices von enddiastolischem LV-Volumen (Median 127 [IQR 96 – 150] vs. 112 [IQR 86 – 150] ml/m²; p = 0,03) und endsystolischem LV Volumen (Median 82 [IQR 54 – 91] vs. 69 [IQR 48 – 99] ml/m²; p = 0,03) zeigte sich jeweils eine signifikante Reduktion nach 6 Monaten im Vergleich zur Erstuntersuchung. Es konnten keine signifikanten Veränderungen der Indices von enddiastolischem RV-Volumen (94 [75 – 103] vs. 99 [77 – 123] ml/m², p = 0,91), endsystolischem RV-Volumen (48 [42 – 80] vs. 51 [40 – 81] ml/m² p = 0,48) und LA-Volumen (87 [55 – 124] vs. 92 [48 – 137] ml/m², p = 0,20) 6 Monate nach MitraClip-Implantation nachgewiesen werden.

Schlussfolgerung: Die kardiale Magnetresonanztomografie erlaubt die Beurteilung kardialer Volumina bei Patienten nach MitraClip-Implantation. Unsere Ergebnisse deuten darüber hinaus auf ein reverses linksventrikuläres, nicht aber rechtsventrikuläres oder linksatriales Remodeling nach perkutaner Mitralklappenrekonstruktion hin.

Kernaussagen:

• Die kardiale Volumetrie mittels kardialer Magnetresonanztomografie ist nach MitraClip-Implantation trotz Artefakten machbar.

• Es ließ sich eine signifikante Reduktion der linksventrikulären Volumina 6 Monate nach perkutaner Mitralklappenrekonstruktion im Sinne eines günstigen, reversen Remodelings nachweisen.

• Signifikante Veränderungen der rechtsventrikulären oder linksatrialen Volumina ließen sich 6 Monate nach perkutaner Mitralklappenrekonstruktion nicht nachweisen.

Key words

heart - interventional procedures - MR imaging - artifacts - safety - echocardiography

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