Multimodality imaging for preprocedural planning of percutaneous mitral valve repair: a comprehensive review

Abstract

New transcatheter mitral valve (MV) therapies are now available as alternatives to surgical and medical treatments in patients at high or prohibitive operative risk. Multimodality imaging including echocardiography, cardiac magnetic resonance, and cardiac computed tomography provide complementary information to guide patient and device selection. Morphology and functional anatomy of the MV should be carefully evaluated to determine the feasibility of percutaneous treatment; to identify the best therapeutic approach, either leaflet or annulus or combined; and to predict the probability of procedural success that is crucial for subsequent outcome and should be integrated by comprehensive preprocedural assessment of chamber size, biventricular systolic and diastolic function, valvopathy hemodynamic impact and aortic or peripheral vascular disease. The spectrum of transcatheter options is now wide and encompasses leaflet repair, direct or indirect annuloplasty, and cordal implantation. The aim of this review is to provide an overview on the role of multimodality imaging in the patient selection and preprocedural planning of percutaneous mitral valve repair.

Keywords

Transcatheter mitral intervention / 3D-echocardiography / multimodality imaging

References

[1] Del Forno B,Agricola E.Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options..Nat Rev Cardiol2020;1-21

[2] Zekry SB,Little SH.Comparative accuracy of two- and three-dimensional transthoracic and transesophageal echocardiography in identifying mitral valve pathology in patients undergoing mitral valve repair: initial observations..J Am Soc Echocardiogr2011;24:1079-85

[3] Faletra FF,Paiocchi VL.Anatomy of mitral annulus insights from non-invasive imaging techniques..Eur Heart J Cardiovasc Imaging2019;20:843-57

[4] Heo R,Hartaigh BÓ.Clinical Implications of Three-Dimensional Real-Time Color Doppler Transthoracic Echocardiography in Quantifying Mitral Regurgitation: A Comparison with Conventional Two-Dimensional Methods..J Am Soc Echocardiogr2017;30:393-403

[5] Nolan MT.Automated Quantification in Echocardiography..JACC Cardiovasc Imaging2019;12:1073-92

[6] Dorosz JL,Weitzenkamp DA,Salcedo EE.Performance of 3-dimensional echocardiography in measuring left ventricular volumes and ejection fraction: a systematic review and meta-analysis..J Am Coll Cardiol2012;59:1799-808 PMCID:PMC3773600

[7] Papadopoulos K,Chrissoheris M.MitraClip and left ventricular reverse remodelling: a strain imaging study..ESC Heart Fail2020;7:1409-18 PMCID:PMC7373921

[8] Baumgartner H,Bax JJ.2017 ESC/EACTS Guidelines for the management of valvular heart disease..Eur Heart J2017;38:2739-91

[9] Zoghbi WA,Bonow RO.Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance..J Am Soc Echocardiogr2017;30:303-71

[10] Zeng X,Hua L.Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography..Circ Cardiovasc Imaging2011;4:506-13 PMCID:PMC3224848

[11] Bartko PE,Heitzinger G.A Unifying Concept for the Quantitative Assessment of Secondary Mitral Regurgitation..J Am Coll Cardiol2019;73:2506-17

[12] Lancellotti P,Dulgheru R,Martinez C.Clinical significance of exercise pulmonary hypertension in secondary mitral regurgitation..Am J Cardiol2015;115:1454-61

[13] Lancellotti P,Piérard LA.Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation..Eur Heart J2005;26:1528-32

[14] Velu JF,de Bruin-Bon HACM.Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair?.Int J Cardiovasc Imaging2019;35:645-51 PMCID:PMC6482124

[15] Uretsky S,Narula J.Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation: Current Evidence..J Am Coll Cardiol2018;71:547-63

[16] Hundley WG,Willard JE.Magnetic resonance imaging assessment of the severity of mitral regurgitation. Comparison with invasive techniques..Circulation1995;92:1151-8

[17] Uretsky S,Lang R.Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial..J Am Coll Cardiol2015;65:1078-88

[18] Fujita N,Hartiala JJ.Quantification of mitral regurgitation by velocity-encoded cine nuclear magnetic resonance imaging..Journal of the American College of Cardiology1994;23:951-8

[19] Gelfand EV,Hauser TH.Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography..J Cardiovasc Magn Reson2006;8:503-7

[20] Lopez-Mattei JC,Shaikh KA.Comparative Assessment of Mitral Regurgitation Severity by Transthoracic Echocardiography and Cardiac Magnetic Resonance Using an Integrative and Quantitative Approach..Am J Cardiol2016;117:264-70

[21] Sachdev V,Sidenko S.Are Echocardiography and CMR Really Discordant in Mitral Regurgitation?.JACC Cardiovasc Imaging2017;10:823-4

[22] Choi J,Hong GR.Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics..Circ Cardiovasc Imaging2014;7:535-44

[23] Thavendiranathan P,Datta S.Quantification of chronic functional mitral regurgitation by automated 3-dimensional peak and integrated proximal isovelocity surface area and stroke volume techniques using real-time 3-dimensional volume color Doppler echocardiography: in vitro and clinical validation..Circ Cardiovasc Imaging2013;6:125-33

[24] Westenberg JJ,Marsan NA.Mitral valve and tricuspid valve blood flow: accurate quantification with 3D velocity-encoded MR imaging with retrospective valve tracking..Radiology2008;249:792-800

[25] Garg P,Zhong L.Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging..Nat Rev Cardiol2020;17:298-312 PMCID:PMC7165127

[26] Myerson SG,Christiansen JP.Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification..Circulation2016;133:2287-96

[27] Penicka M,Mirica DC,Kockova R.Prognostic Implications of Magnetic Resonance-Derived Quantification in Asymptomatic Patients With Organic Mitral Regurgitation: Comparison With Doppler Echocardiography-Derived Integrative Approach..Circulation2018;137:1349-60

[28] Cavalcante JL,Obuchowski NA.Prognostic Impact of Ischemic Mitral Regurgitation Severity and Myocardial Infarct Quantification by Cardiovascular Magnetic Resonance..JACC Cardiovasc Imaging2020;13:1489-501

[29] Marra MP,De Lazzari M.Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse..Circ Cardiovasc Imaging2016;9:e005030 PMCID:PMC4991345

[30] Miller MA,Turagam M,Adams DH.Arrhythmic mitral valve prolapse: JACC review topic of the week..J Am Coll Cardiol2018;72:2904-14

[31] Rowin EJ,Maron MS.The hypertrophic cardiomyopathy phenotype viewed through the prism of multimodality imaging: clinical and etiologic implications..JACC Cardiovasc Imaging2020;13:2002-16

[32] Faggioni L,Accogli S.Preprocedural planning of transcatheter mitral valve interventions by multidetector CT: what the radiologist needs to know..Eur J Radiol Open2018;5:131-40 PMCID:PMC6120726

[33] Khalique OK.Multimodality imaging in transcatheter mitral interventions: buzzword or modern age toolbox?.Circ Cardiovasc Imaging2016;9:e005071

[34] Kim SS,Song MG.Quantification of stenotic mitral valve area and diagnostic accuracy of mitral stenosis by dual-source computed tomography in patients with atrial fibrillation: comparison with cardiovascular magnetic resonance and transthoracic echocardiography..Int J Cardiovasc Imaging.2015;31 Suppl 1:103-14

[35] van Rosendael PJ,Kamperidis V.Integrated imaging of echocardiography and computed tomography to grade mitral regurgitation severity in patients undergoing transcatheter aortic valve implantation..Eur Heart J2017;38:2221-6

[36] Alfieri O,De Bonis M.The double-orifice technique in mitral valve repair: a simple solution for complex problems..J Thorac Cardiovasc Surg2001;122:674-81

[37] Melillo E,Buzzatti N,Agricola E.A challenging mitral valve anatomy for percutaneous repair with MitraClip: cleft posterior leaflet..Eur Heart J Cardiovasc Imaging2019;20:1433-4

[38] Puls M,Boekstegers P.One-year outcomes and predictors of mortality after MitraClip therapy in contemporary clinical practice: results from the German transcatheter mitral valve interventions registry..Eur Heart J2016;37:703-12 PMCID:PMC4761401

[39] Godino C,Taramasso M.Two-year cardiac mortality after MitraClip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy..Int J Cardiol2018;269:33-9

[40] Kaneko H,Weissenborn J.Prognostic Significance of Right Ventricular Dysfunction in Patients With Functional Mitral Regurgitation Undergoing MitraClip..Am J Cardiol2016;118:1717-22

[41] Grayburn PA,Packer M.Proportionate and Disproportionate Functional Mitral Regurgitation: A New Conceptual Framework That Reconciles the Results of the MITRA-FR and COAPT Trials..JACC Cardiovasc Imaging2019;12:353-62

[42] Gaasch WH,Meyer TE.An Appraisal of the Association of Clinical Outcomes With the Severity of Regurgitant Volume Relative to End-Diastolic Volume in Patients With Secondary Mitral Regurgitation..JAMA Cardiol2020;5:476-81

[43] Ciarka A,Delgado V.Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty..Am J Cardiol2010;106:395-401

[44] Goldstein D,Gelijns AC.Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation..N Engl J Med2016;374:344-53 PMCID:PMC4908819

[45] Spencer JH,Iaizzo PA.The prevalence of coronary sinus and left circumflex artery overlap in relation to the mitral valve..J Interv Cardiol2014;27:308-16

[46] Bax JJ,Lancellotti P.Transcatheter interventions for mitral regurgitation: multimodality imaging for patient selection and procedural guidance..JACC Cardiovasc Imaging2019;12:2029-48

[47] Tops LF,Schuijf JD.Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus: implications for percutaneous mitral annuloplasty..Circulation2007;115:1426-32

[48] Schofer J,Haude M.Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON Mitral Annuloplasty Device European Union Study..Circulation2009;120:326-33 PMCID:PMC3954526

[49] Seeburger J,Nielsen SL.Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept..J Am Coll Cardiol2014;63:914-9

[50] Gammie JS,Bartus K.Transapical beating-heart mitral valve repair with an expanded polytetrafluoroethylene cordal implantation device: initial clinical experience..Circulation2016;134:189-97

[51] Rucinskas K,Zakarkaite D.Off-pump transapical implantation of artificial chordae to correct mitral regurgitation: early results of a single-center experience..J Thorac Cardiovasc Surg2014;147:95-9

[52] Colli A,Zucchetta F.Transapical off-pump mitral valve repair with Neochord implantation: Early clinical results..Int J Cardiol2016;204:23-8