Abstract 20044: Percutaneous Mitral Annuloplasty is Associated with Durable Reduction in Functional Mitral Regurgitation and Left Ventricular Reverse Remodeling in Patients with Symptomatic Heart Failure
Background: Functional mitral regurgitation (FMR) in patients with heart failure (HF) is associated with worse outcomes. The long term impact of percutaneous mitral annuloplasty (PMA) on FMR severity and left ventricular (LV) structure and function are not well described.
Methods: The TITAN trial of PMA with the CARILLON® Mitral Contour System™ enrolled 53 patients with NYHA Class II-IV HF, moderate to severe FMR, LVEF<40%, and LV end-diastolic dimension>55mm. Of these, 36 were successfully implanted; 17 were not implanted due to lack of acute intraprocedural FMR reduction, or impingement of coronary flow by the device. Nine implanted patients died by 12 months (m) and 2 were lost to follow-up, leaving 25 implanted patients with follow-up to 1 year, with serial echos at baseline, 6 m and 12 m post-implantation. We evaluated these subjects for changes in quantitative FMR and LV structure and function, using comprehensive ASE criteria.
Results: At 6 m, FMR decreased by 3 grades in 1 (4%), 2 grades in 5 (20%), and 1 grade in 13 (52%). No reduction in FMR grade was seen in 6 (24%). At 12 m, FMR further decreased by 1 grade in 5 (20%), 2 grades in 1 (4%), and worsened by 1 grade in 2 (8%). Overall, at 6 m, implanted patients experienced significant reductions in quantitative FMR parameters and end-systolic volume (ESV) (table). By 12 m, reductions in quantitative FMR parameters persisted in association with significant reductions in ESV and end-diastolic volume (EDV) (table).
Conclusions: Among successfully implanted subjects who survived to 12 m post-implant, PMA was associated with an early and durable reduction in FMR severity and subsequent associated improvements in LV remodeling in a sizeable proportion of subjects.
- © 2010 by American Heart Association, Inc.