TY - JOUR
T1 - Novel Multiphase Assessment for Predicting Left Ventricular Outflow Tract Obstruction Before Transcatheter Mitral Valve Replacement
AU - Meduri, Christopher U.
AU - Reardon, Michael J.
AU - Lim, D. Scott
AU - Howard, Elliot
AU - Dunnington, Gan
AU - Lee, David P.
AU - Liang, David
AU - Gooley, Robert
AU - O'Hair, Daniel
AU - Ng, Martin K.
AU - Walton, Antony
AU - Spargias, Konstantinos
AU - Blackman, Daniel
AU - Coisne, Augustin
AU - Hildick-Smith, David
AU - De Gouy, Marine
AU - Chenoweth, Sharla
AU - Kar, Saibal
AU - McCarthy, Patrick M.
AU - Piazza, Nicolo
AU - Qasam, Atif
AU - Martin, Randolph P.
AU - Leon, Martin B.
AU - Mack, Michael J.
AU - Adams, David H.
AU - Bapat, Vinayak
N1 - Funding Information:
Jessica Dries-Devlin, PhD, CMPP, an employee of Medtronic, provided medical writing support under the direction of the lead authors.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/12/9
Y1 - 2019/12/9
N2 - Objectives: This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Background: Patients considered for transcatheter mitral valve replacement trials often screen-fail because of the perceived risk of LVOTO. In the Intrepid Global Pilot Study, assumed risk of LVOTO was based on computed tomography estimates of the neo-LVOT area computed at end-systole. However, this may overestimate actual risk. Methods: Retrospective analyses were performed for screen-failed patients for potential LVOTO (n = 33) and treated patients (n = 29) with available dynamic computed tomography. A multiphase assessment of the neo-LVOT area was performed and represented as: 1) multiphase average; and 2) early systolic value. Prospective evaluation was performed in 9 patients approved for enrollment with multiphase and early systole methods that would have previously screen-failed with the end-systolic approach. Results: Of 166 patients screened for possible inclusion; 32 were screen-failed for nonanatomical reasons. Screen failure for assumed LVOTO risk occurred in 37 of 134 (27.6%) patients. Retrospective analysis indicated a potential enrollment increase of 11 of 33 (33.3%) and 18 of 33 (54.5%) patients using multiphase and early systolic assessment methods. In the prospective cohort, there were no clinical observations of LVOTO 30 days post-procedure, despite assumed risk based on end-systolic estimates. Conclusions: Multiphase, and specifically early systolic, assessment of the neo-LVOT may better determine risk of LVOTO with transcatheter mitral valve replacement compared with end-systolic estimates. This novel approach has the potential to significantly increase patient eligibility, with over one-half of patients previously screen-failed now eligible for treatment.
AB - Objectives: This study proposes a physiologic assessment of left ventricular outflow tract obstruction (LVOTO) that accommodates changes in systolic flow and accounts for the dynamic neo–left ventricular outflow tract (LVOT). Background: Patients considered for transcatheter mitral valve replacement trials often screen-fail because of the perceived risk of LVOTO. In the Intrepid Global Pilot Study, assumed risk of LVOTO was based on computed tomography estimates of the neo-LVOT area computed at end-systole. However, this may overestimate actual risk. Methods: Retrospective analyses were performed for screen-failed patients for potential LVOTO (n = 33) and treated patients (n = 29) with available dynamic computed tomography. A multiphase assessment of the neo-LVOT area was performed and represented as: 1) multiphase average; and 2) early systolic value. Prospective evaluation was performed in 9 patients approved for enrollment with multiphase and early systole methods that would have previously screen-failed with the end-systolic approach. Results: Of 166 patients screened for possible inclusion; 32 were screen-failed for nonanatomical reasons. Screen failure for assumed LVOTO risk occurred in 37 of 134 (27.6%) patients. Retrospective analysis indicated a potential enrollment increase of 11 of 33 (33.3%) and 18 of 33 (54.5%) patients using multiphase and early systolic assessment methods. In the prospective cohort, there were no clinical observations of LVOTO 30 days post-procedure, despite assumed risk based on end-systolic estimates. Conclusions: Multiphase, and specifically early systolic, assessment of the neo-LVOT may better determine risk of LVOTO with transcatheter mitral valve replacement compared with end-systolic estimates. This novel approach has the potential to significantly increase patient eligibility, with over one-half of patients previously screen-failed now eligible for treatment.
KW - LVOT
KW - TMVR
KW - left ventricular outflow tract obstruction
KW - mitral valve
KW - neo-LVOT
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UR - http://www.scopus.com/inward/citedby.url?scp=85075314211&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2019.06.015
DO - 10.1016/j.jcin.2019.06.015
M3 - Article
C2 - 31629753
AN - SCOPUS:85075314211
VL - 12
SP - 2402
EP - 2412
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 23
ER -