Snijders, Bengt (2022) Novel pre-procedural echocardiographic predictors of clinical outcome following a MitraClip intervention for severe mitral valve regurgitation. thesis, Medicine.
Full text available on request.Abstract
Introduction: Severe mitral regurgitation (MR) is associated with high morbidity and mortality. Mitral valve (MV) surgery is indicated in case of symptomatic and/or progressive MR. However, for a large patient population surgery is a high-risk procedure due to age and comorbidities. At the same time the prevalence of severe MR increases with age. An alternative for MV surgery is a less invasive transcatheter repair of the MV by MitraClip. Current research on clinical outcome and patient risk stratification is limited. There is a lack in aetiology specific understanding and echocardiographic predictors associated with the clinical MitraClip outcome. The aim of this study is to pin down echocardiographic predictors associated with MitraClip results in order to improve outcome predictability. Method: 175 MitraClip patients between 2011 and 2021 were retrospectively analysed. The patients were divided based on MR aetiology, namely degenerative MR (DMR) and functional MR (FMR). Differences between these groups were examined and cardiovascular (CV) death and Major adverse cardiac events (MACE) events during the follow-up were collected. Results: A total of 57 DMR patients and 118 FMR patients were analysed. Age, EuroSCORE II, creatinine and NT-ProBNP differed significantly between DMR and FMR patients. Moreover, in the total patient group (DMR/FMR) left atrial (LA) volume, left ventricular (LV) mass, LV mass index, LV end systolic and diastolic diameter (LVEDD and LVESD) and deceleration time of the early mitral inflow velocity (MV DecT) were independently associated with CV death. LA volume index (LAVi), right atrial (RA) Major, RA Minor, LVESD and LV mass index were significantly associated with MACE occurring. For the FMR patients LA major, LA volume, LAVi, LV mass, LV mass index, left ventricular outflow tract (LVOT) Vmax and LVOT maxPG were associated with CV death and LA volume, LAVi, RA areas (RAAs), RA Major, RA Minor, LV mass index with MACE. Conclusion: For the overall DMR/FMR multivariate model MV DecT and LA volume were significant predictors for the CV death endpoint and LVESD, RA Major, RA Minor and LV mass index for the overall MACE model. It can be concluded that inclusion of additional echocardiographic parameters results in improved MitraClip risk models.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Voors, Prof. Dr. A.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 04 Jul 2023 11:40 |
| Last Modified: | 04 Jul 2023 11:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3572 |
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