Echocardiogram should play role in patient selection for transcatheter mitral valve repair, says study

Echocardiograms may be one of several essential components necessary for determining if valve repair is appropriate for patients with heart failure and a leaking heart valve

March 20, 2019
by John R. Fischer , Staff Reporter
An echocardiogram may be one of several essential components necessary for determining if valve repair is likely to help patients suffering from heart failure and a leaking heart valve.

Presented in a new study this past weekend at the American College of Cardiology 68th Annual Scientific Session in New Orleans, the finding builds on the research of the COAPT trial, which explored the use of transcatheter mitral valve repair in patients with secondary mitral regurgitation. Specifically, the focus of the ultrasound component was to depict what the valve looked like and assess the significance of the valvular disease.

“We use ultrasound as an initial way of evaluating any patient or any kind of cardiac condition. It allows us to look at the valves and how the walls in the heart move, and whether there are abnormal structures within the heart,” Dr. Federico Asch, physician and director of Cardiovascular Core Laboratories at MedStar Health Research Institute in Washington, D.C., and one of the authors of the new study, told HCB News. “With the mitral valve in particular, we need to determine not only if the anatomy of the valve and the heart is suitable for an intervention and a device like the MitraClip in this case, but also what the physiology is and how significant the valvular disease is.”

Though routinely used to analyze mitral regurgitation, no worldwide standard involving echocardiograms exists for diagnosing secondary mitral regurgitation, limiting its use. By detailing the role of echocardiography, along with other components such as an algorithm used, the study aims to establish such a guideline for clinical decision making, using COAPT as a basis.

The COAPT trial consisted of 614 patients treated at 78 medical centers across the U.S. and Canada who underwent echocardiograms prior to enrollment. Each were either randomly assigned to receive a MitraClip or maximally-tolerated therapy based on clinical guidelines, which can include diuretics, beta blockers, and sometimes, cardiac resynchronization therapy. All had heart failure and moderate-to-severe secondary mitral regurgitation, both of which commonly coexist with one another can worsen a patient’s symptoms.

Researchers utilized echocardiography again at follow-up visits at one, six, 12, 18 and 24 months, deploying a multi-parametric algorithm to interpret heart images, evaluate the function of the valve and determine if patients were appropriate candidates for the MitraClip procedure. The follow-up assessments indicated that the repaired valve prevented backward flow of the blood through the valve, even throughout the two years of follow-up.

Researchers also found TMVR to be an equal asset across all subgroups in the study, regardless of size, function or pressures of the heart’s chambers, asserting that patients with similar characteristics in the trial should be considered for such interventions.

While essential, Asch says the role of ultrasound is only one of many essential components that play a role in determining if a procedure is suitable for a specific patient, and should not be regarded as the only one.

“Ultrasound is used in the context of clinical care. Therefore, there are multiple things that need to be put together with the ultrasound,” he said. “The specific role of the ultrasound here is to understand what the valve looks like and how significant the valvular disease is. Those are the things that make ultrasound very unique and make its specific role in the evaluation of mitral regurgitation. So, it’s not only that we need the ultrasound to determine if a patient should have a procedure such as this, but it’s a critical component in this evaluation.”

The algorithm was adapted from the American Society of Echocardiography and ACC guidelines.

The study was funded by Abbott.

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