MitraClip improves cardiopulmonary exercise test in patients with systolic heart failure and functional mitral regurgitation

• Published in: ESC Heart Failure Vol. 6; no. 4; pp. 867 - 873
• Main Authors: Benito‐González, Tomás, Estévez‐Loureiro, Rodrigo, Garrote‐Coloma, Carmen, Iglesias Garriz, Ignacio, Gualis, Javier, Álvarez‐Roy, Laura, Rodriguez‐Santamarta, Miguel, Pérez de Prado, Armando, Fernández‐Vázquez, Felipe
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-08-2019; John Wiley and Sons Inc; Wiley
• Subjects: Aged; Anaerobic threshold; Cardiac Surgical Procedures - instrumentation; Cardiology; Cardiopulmonary stress test; Cardiovascular disease; Catheters; Chronic obstructive pulmonary disease; Coronary vessels; Ejection fraction; Exercise Test; Female; Fitness equipment; Functional mitral regurgitation; Heart failure; Heart Failure, Systolic - complications; Heart Failure, Systolic - physiopathology; Humans; Kidney diseases; Male; Maximal O2 consumption; Medical prognosis; Middle Aged; MitraClip; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - surgery; Prospective Studies; Short Communication; Short Communications; Stroke Volume; Surgical Instruments; Treatment Outcome; New York; Functional mitral regurgitation; MitraClip; Cardiopulmonary stress test; Maximal O2 consumption
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.12457

Aims
The aim of this study is to evaluate changes in cardiopulmonary exercise test (CPET) after percutaneous mitral valve repair (PMVR) with MitraClip in patients with heart failure with reduced ejection fraction who are potentially candidates for heart transplantation or destination left ventricular assist device.
Methods and results
Prospective registry of all consecutive patients with heart failure with reduced ejection fraction and functional mitral regurgitation (MR) underwent elective PMVR between October 2015 and March 2018 in our institution. Patients with preserved or mid‐range left ventricular ejection fraction (>40%), advanced age (>75 years old), or severe co‐morbidities (end‐stage organ damage) were not included. Treadmill exercise testing with respiratory gas exchange analysis was carried out in 11 patients (male, 72.7%; median age, 67 years old) within the month prior to the procedure and at 6 month follow‐up. PMVR was successfully performed in all patients. At 6 month follow‐up, PMVR was associated with an improvement in New York Heart Association functional class (P = 0.021) and a reduction in MR severity (P = 0.013) and N‐terminal pro‐brain natriuretic peptide levels (2805 [1878–5022] vs. 1485 [654–3032] pg/mL; P = 0.012). All patients completed pre‐procedural and post‐procedural CPET, and all the studies showed a respiratory exchange ratio ≥1 and were consistent with sufficient exercise effort. Compared with pre‐procedural CPET, patients showed a significant increase in exercise time (295 [110–335] vs. 405 [261–540] s; P = 0.047), VO2 (9.8 [9.1–13.4] vs. 13.5 [12.1–16.8] mL/kg/min; P = 0.033), ventilatory anaerobic threshold (510 [430–950] vs. 850 [670–1070] mL/kg/min; P = 0.033), peak O2 pulse (7.2 [4.3–8.6] vs. 8.3 [6.2–11.8] mL/beat; P = 0.033), and workload (5 [3–6] vs. 6 [5–8] metabolic equivalents; P = 0.049).
Conclusions
Percutaneous mitral valve repair with MitraClip was associated with an enhancement in cardiopulmonary performance in patients with systolic heart failure and secondary MR.