Association of Mitral Valve Geometry at CT with Secondary Mitral Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Aortic Regurgitation

TL;DR

This study identifies CT-based mitral valve measurements that predict persistent mitral regurgitation after aortic valve replacement in patients with aortic regurgitation.

Contribution

The study introduces CT-derived mitral valve geometry as novel predictors of secondary mitral regurgitation outcomes after TAVR.

Findings

Mitral annular area and mitral valve tenting area were independent predictors of persistent secondary mitral regurgitation after TAVR.

Larger mitral annular dimensions and increased tenting geometry were associated with worse mitral regurgitation improvement.

QRS duration >120 ms and atrial fibrillation also influenced mitral regurgitation outcomes.

Abstract

The improvement rate and predictors of secondary mitral
regurgitation in patients with aortic regurgitation undergoing transcatheter
aortic valve replacement (TAVR) remain unclear. This study aimed to identify
predictors of persistent moderate to severe secondary mitral regurgitation after
TAVR in patients with aortic regurgitation by assessing mitral valve geometry
with computed tomography (CT).

This retrospective cohort study
reviewed 242 consecutive patients with aortic regurgitation who underwent TAVR
between May 2014 and December 2022. Patients with primary or less than moderate
mitral regurgitation were excluded. Mitral annular dimensions (area, perimeter,
anteroposterior, intercommissural, and trigone-to-trigone diameter), mitral valve
tenting geometry (mitral valve tenting area [MVTA] and mitral valve tenting
height [MVTH]), and papillary muscle displacement were systematically measured at
CT. Mitral regurgitation improvement was assessed at 3 months after TAVR by
echocardiography. Logistic regression was performed to explore the association of
mitral valve geometry with mitral regurgitation improvement after TAVR.

A total of 75 patients (mean age, 74 ± 7 years; 32.0%
female) with moderate to severe secondary mitral regurgitation were included in
the final analysis. Mitral regurgitation improved in 49 patients and remained
unchanged in 26 patients. Mitral annular dimensions, including area, perimeter,
anteroposterior, and intercommissural diameter, were associated with mitral
regurgitation improvement. MVTA and MVTH were risk factors for sustained mitral
regurgitation. In addition, QRS duration >120 ms and atrial fibrillation had an
impact on the mitral regurgitation improvement. Mitral annular area (odds ratio
[OR], 1.41; 95% confidence interval [CI]: 1.05, 1.90; p = 0.02) and
MVTA (OR, 7.24; 95% CI: 1.72, 30.44; p = 0.007) were independent
predictors of persistent secondary mitral regurgitation after TAVR.

Mitral annular area and MVTA were independent predictors of
persistent secondary mitral regurgitation after TAVR.

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