Skip to main content
SpringerLink
Log in

Changes in exercise stress echocardiographic parameters before and after transcatheter mitral valve edge-to-edge repair

  • Original Article
  • Published:
Cardiovascular Intervention and Therapeutics Aims and scope Submit manuscript

Abstract

The safety and feasibility are still not well known for exercise-induced mitral regurgitation (MR). This study is aimed to assess and compare the hemodynamic and symptomatic changes in patients with significant secondary MR during exercise stress echocardiography (ESE) before and after transcatheter edge-to-edge repair (TEER). The study included a total of 15 patients with secondary MR who underwent ESE before and after TEER using the MitraClip system (Abbott, Abbott Park, IL, USA). Echocardiographic data of ESE were collected both before the procedure and during the follow-up visit at 3 months. During the one-year postoperative observation period, the rate of readmission due to heart failure was 13% (n = 2), with no recorded fatalities. Although no significant differences of ESE data were observed in exercise-induced pulmonary hypertension or cardiac output before and after the repair, the severity of MR was significantly improved after the procedure, both at rest (2 [2–3] vs. 1 [1–2], p = 0.0125) and during ESE (3 [3–3] vs. 1 [1–1], p < 0.0001). Furthermore, the New York Heart Association Functional Classification was improved (3 [3–3] vs. 1 [1–1], p < 0.0001) after treatment. For a supplemental analysis, MR during ESE was significantly improved not only in cases with atrial secondary MR but also in ventricular secondary MR. Transcatheter edge-to-edge repair for exercise-induced MR resulted in a significant improvement in postoperative MR severity and subjective symptoms. These results are novel, as they have not been extensively reported previously, particularly among Japanese patients.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article.

References

  1. Sannino A, Smith RL, Schiattarella GG, Trimarco B, Esposito G, Grayburn PA. Survival and cardiovascular outcomes of patients with secondary mitral regurgitation: a systematic review and meta-analysis. JAMA Cardiol. 2017;2:1130–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mack MJ, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol. 2021;77:1029–40.

    Article  PubMed  Google Scholar 

  3. Suzuki T, Izumo M, Suzuki K, Koto D, Tsukahara M, Teramoto K, et al. Prognostic value of exercise stress echocardiography in patients with secondary mitral regurgitation: a long-term follow-up study. J Echocardiogr. 2019;17:147–56.

    Article  PubMed  Google Scholar 

  4. Lebrun F, Lancellotti P, Pierard LA. Quantitation of functional mitral regurgitation during bicycle exercise in patients with heart failure. J Am Coll Cardiol. 2001;38:1685–92.

    Article  CAS  PubMed  Google Scholar 

  5. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.

    Article  PubMed  Google Scholar 

  6. Obokata M, Kane GC, Sorimachi H, Reddy YNV, Olson TP, Egbe AC, et al. Noninvasive evaluation of pulmonary artery pressure during exercise: the importance of right atrial hypertension. Eur Respir J. 2020;55:1901617.

    Article  PubMed  Google Scholar 

  7. Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, et al. Mitral Valve Academic Research Consortium (MVARC). Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 1: clinical trial design principles: a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol. 2015;66:278–307.

    Article  PubMed  Google Scholar 

  8. Nickenig G, Estevez-Loureiro R, Franzen O, Tamburino C, Vanderheyden M, Lüscher TF, et al. Transcatheter Valve Treatment Sentinel Registry Investigators of the EURObservational Research Programme of the European Society of Cardiology. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011–2012 Pilot European Sentinel Registry. J Am Coll Cardiol. 2014;64:875–884.

  9. Pighi M, Estevez-Loureiro R, Maisano F, Ussia GP, Dall’Ara G, Franzen O, et al. Transcatheter Valve Treatment Sentinel Registry (TCVT) Investigators of the EURObservational Research Programme (EORP) of the European Society of Cardiology. Immediate and 12-month outcomes of ischemic versus nonischemic functional mitral regurgitation in patients treated with MitraClip (from the 2011 to 2012 Pilot Sentinel Registry of Percutaneous Edge-To-Edge Mitral Valve Repair of the European Society of Cardiology). Am J Cardiol 2017;119:630–637.

  10. Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014;64:182–92.

    Article  PubMed  Google Scholar 

  11. Puls M, Tichelbacker T, Bleckmann A, Hünlich M, von der Ehe K, Beuthner BE, et al. Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip. EuroIntervention. 2014;9:1407–17.

    Article  PubMed  Google Scholar 

  12. Glower DD, Kar S, Trento A, Lim DS, Bajwa T, Quesada R, et al. Percutaneous mitral valve repair for mitral regurgitation in high-risk patients: results of the EVEREST II study. J Am Coll Cardiol. 2014;64:172–81.

    Article  PubMed  Google Scholar 

  13. Bertrand PB, Verbrugge FH, Verhaert D, Smeets CJ, Grieten L, Mullens W, et al. Mitral valve area during exercise after restrictive mitral valve annuloplasty: importance of diastolic anterior leaflet tethering. J Am Coll Cardiol. 2015;65:452–61.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Harada T, Kagami K, Kato T, Ishii H, Obokata M. Exercise stress echocardiography in the diagnostic evaluation of heart failure with preserved ejection fraction. J Cardiovasc Dev Dis. 2022;9:87.

    PubMed  PubMed Central  Google Scholar 

  15. Siegel RJ, Biner S, Rafique AM, Rinaldi M, Lim S, Fail P, et al. The acute hemodynamic effects of MitraClip therapy. J Am Coll Cardiol. 2011;57:1658–65.

    Article  PubMed  Google Scholar 

  16. de Wit F, van Vliet AL, de Wilde RB, Jansen JR, Vuyk J, Aarts LP, et al. The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistances. Br J Anaesth. 2016;16:784–9.

    Article  Google Scholar 

  17. Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, et al. Impact of transcatheter edge-to-edge mitral valve repair on guideline-directed medical therapy uptitration. JACC Cardiovasc Interv. 2023;16:896–905.

    Article  PubMed  Google Scholar 

  18. Neuss M, Schau T, Isotani A, Pilz M, Schopp M, Butter C. Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure. Cardiovasc Interv. 2017;10:931–9.

    Google Scholar 

  19. Picano E, Pibarot P, Lancellotti P, Monin JL, Bonow RO. The emerging role of exercise testing and stress echocardiography in valvular heart disease. J Am Coll Cardiol. 2009;54:2251–60.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, Japan

    Risako Murata, Shingo Kuwata, Masaki Izumo, Yukio Sato, Taishi Okuno, Masashi Koga, Kazuaki Okuyama, Yasuhiro Tanabe, Tomoo Harada, Yuki Ishibashi & Yoshihiro Johnny Akashi

  2. Ultrasound Center, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan

    Noriko Shiokawa

Authors
  1. Risako Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shingo Kuwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaki Izumo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noriko Shiokawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yukio Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Taishi Okuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Koga
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuaki Okuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasuhiro Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomoo Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yuki Ishibashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yoshihiro Johnny Akashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shingo Kuwata.

Ethics declarations

Conflict of interest

S. Kuwata and M. Izumo are consultants for Abbott. The other authors declare that there are no conflicts of interest. No funding was received for this study.

Ethical approval

The ethics committee of St. Marianna University School of Medicine approved the study protocol (approval number: 5262). All patients received thorough verbal and written explanations about the TEER procedure and signed informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 24 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murata, R., Kuwata, S., Izumo, M. et al. Changes in exercise stress echocardiographic parameters before and after transcatheter mitral valve edge-to-edge repair. Cardiovasc Interv and Ther 39, 74–82 (2024). https://doi.org/10.1007/s12928-023-00966-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12928-023-00966-3

Keywords

Search

Navigation