Use of Left Ventricular Global Longitudinal Strain to predict Reverse
Left Ventricular Remodeling after MitraClip repair
Abstract
Background: Mitral Regurgitation (MR) can cause left ventricular
dilation (remodeling). Reverse remodeling describes improved volumes
after intervention. Reverse remodeling carries favorable prognoses, but
not all MitraClip patients undergo reverse remodeling. We hypothesized
pre-procedural global longitudinal strain (pre-GLS) will predict reverse
remodeling one-year post MitraClip in all-cause MR patients. Materials
and Methods: Of the 189 MitraClips performed at our institution between
2007-2019, 57 patients had complete echocardiographic data,.
Echocardiograms 0-120 days prior to and 6-24 months after procedure were
retrospectively reviewed. Reverse remodeling was defined as reduction in
end diastolic volume (EDV). Results: In 20 sample echocardiograms, intra
and inter-reader GLS variability was r=0.95 and r=0.90, respectively.
Our population consisted of 55.2% female, 12.3% functional , 61.4%
degenerative and 26.3% mixed mitral regurgitation. A reduction in EDV
was demonstrated in 38 patients (67%). EDV, ESV, LAVi, and RVSP
significantly decreased post-clip (all p<0.01) but not LVEF.
Regression models showed pre-EDV (p<0.01) and pre-ESV
(p<0.01) had significant crude and adjusted linear
associations and │pre-GLS│ had a significant crude curvilinear
association (linear p=0.04, quadratic p =0.04) with EDV reductions post
clip. The curvilinear association showed among lower, more abnormal
│pre-GLS│ values, higher │pre-GLS│ was associated with greater
reductions in EDV. When adjusted for pre-EDV and pre-ESV, GLS lost
significance(linear p=0.29, quadratic p=0.29). Conclusion: Our study
shows a majority of MitraClip patients demonstrate reverse remodeling
and pre-GLS to be associated with reverse remodeling, though not
robustly. Further study with large sample sizes can better define the
association.