Cardiac magnetic resonance imaging in patients undergoing percutaneous mitral valve repair with the MitraClip system

• Published in: Clinical research in cardiology Vol. 103; no. 5; pp. 397 - 404
• Main Authors: Krumm, Patrick, Zuern, Christine S., Wurster, Thomas H., Mangold, Stefanie, Klumpp, Bernhard D., Henning, Andreas, Mueller, Iris I., Bretschneider, Christiane, Bauer, Axel, Kramer, Ulrich, May, Andreas E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2014; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Cardiology; Cohort Studies; Feasibility Studies; Female; Follow-Up Studies; Germany; Heart Function Tests; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Humans; Magnetic Resonance Imaging, Cine - methods; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - surgery; Original Paper; Patient Safety; Prospective Studies; Prosthesis Design; Risk Assessment; Surgical Instruments; Treatment Outcome; Germany; Mitral regurgitation; Mitral insufficiency; MitraClip; Percutaneous mitral valve repair; Cardiac magnetic resonance imaging
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-014-0670-x

Background Percutaneous mitral valve repair (MVR) with the MitraClip ® system in patients with mitral regurgitation (MR) is known to reduce symptoms and to improve cardiac morphology and function. MitraClip has been approved for cardiac magnetic resonance imaging (MRI). To date, however, no systematic analysis exists on cardiac MRI in patients undergoing the MitraClip procedure. Objective The aim of this study was to (1) prove feasibility and robustness of cardiac MRI and (2) visualize effects of the procedure on cardiac morphology and function by cardiac MRI. Methods 27 consecutive patients (age 77.5 ± 7.6 years) with symptomatic moderate to severe MR undergoing the MitraClip ® procedure were prospectively included. Cardiac MRI at 1.5 T was performed before and at 3 months after intervention. Cardiac morphology and function were evaluated using steady-state free precession (SSFP) cine sequences by assessment of left ventricular enddiastolic and endsystolic diameters (LVEDD, LVESD) and volumes (EDV, ESV), ejection fraction (LVEF) and stroke volume (SV), diameter of mitral annulus, and myocardial mass (MM). Planimetry of the left atrium (LA) was performed in identical slices in a four-chamber view. Results Around the clip an extinction artifact was observed which did not disturb the evaluation of cardiac morphology and function. At follow-up, we observed significant decreases of LVEDD (58.0 to 53.3 mm, p  < 0.0001), EDV (167 to 159 mL, p  = 0.0006) and ESV (101 to 89 mL, p  < 0.0001), diameter of mitral annulus (41.4 to 37.9 mm, p  < 0.0001), myocardial mass (148.4 to 144.5 g, p  = 0.0004) and LA size (40.2 to 37.6 cm 2 , p  < 0.0001). LVEF improved (43.3 to 46.7 %, p  = 0.0041). Conclusions Cardiac MRI is feasible and robust in patients with MitraClips. The clinical benefit of a successful MitraClip intervention is paralleled by significant improvements of cardiac morphology and function which can be monitored and validated using MRI in clinical follow-up examinations.