Transesophageal Echocardiography For The Assessment of Left Atrial Pressure After Trans-Septal Mitral Valve Interventions
Authors/Creators
- 1. Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxo- logico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
- 2. Kantonsspital Aarau, Aarau, Switzerland;
- 3. HerzZentrum Hirslanden Zurich, Zurich, Switzerland;
- 4. Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxo- logico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy;
- 5. Angiology Department, University of Z€urich, Z€urich, Swit- zerland;
- 6. Cardiac Surgery Department, Cardiocentro Ticino, Lugano, Swit- zerland;
- 7. Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milano, Italy.
Description
The measure of left atrial pressure (LAP) is an ideal marker for the clinical efficacy of
transcatheter mitral valve intervention. Currently, only the invasive measurement of LAP
(i-LAP) is available and no echocardiographic methods are reliable in the setting of trans-
catheter mitral valve intervention. This study sought to validate a new echocardiographic
method for the estimation of LAP (e-LAP) by comparing it with i-LAP. During percutane-
ous edge-to-edge procedure with MitraClip, the i-LAP was routinely monitored. Across
the iatrogenic interatrial septum defect, the flow was sampled with continuous-wave Dopp-
ler echocardiography for deriving the mean pressure gradient between the left atrium and
the right atrium, and the central venous pressure was added to obtain the e-LAP. The cor-
relation between the measures derived from these 2 methods was explored. A total of 34
consecutive patients were included. Intraclass correlation coefficient between e-LAP and
i-LAP was high (intraclass correlation coefficient [95% confidence interval] 0.809 [0.625
to 0.902], R Pearson 0.6, p <0.001); a bias of 1.3 mm Hg for e-LAP versus i-LAP was
found (p = 0.32). The median follow-up was 108 days (interquartile range 40 to 264). No
death occurred and 6 patients were rehospitalized for heart failure. Postimplant e-LAP
was correlated with rehospitalization at follow-up (hazard ratio 1.46, 95% confidence
interval 1.022 to 2.1, p = 0.038). A cut-off value of 9.5 mm Hg for the e-LAP was identified
as predictor of rehospitalization for heart failure. The evaluation of e-LAP has optimal
reliability compared with i-LAP; a value more than 9.5 mm Hg was found to be related to
higher risk of events at short follow-up. © 2022 Elsevier Inc. All rights reserved. (Am J
Cardiol 2022;00:1−8)
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