ABSTRACT
INTRODUCTION: Accurate predictors of good clinical response after MitraClip implant in patients with heart failure (HF) are still lacking. Aim of this study was to investigate the role of regurgitant fraction >50% as a marker of disproportionate functional mitral regurgitation (FMR) in identifying best responders to Mitraclip. METHODS AND RESULTS: Data from 58 advanced HF patients (age 66⯱â¯8â¯years, 81% males, 63% NYHA class IV, LV ejection fraction (EF) 25.5⯱â¯5.5%) with disproportionate and proportionate FMR who underwent successful MitraClip implant were analyzed. After MitraClip all patient achieved mild (≤ 2+/4+) MR. During 12-month follow-up 18 patients (31%) had a major adverse cardiac event (MACE, i.e. cardiac death, urgent LVAD implant or heart transplantation, HF hospitalization). Disproportionate FMR (nâ¯=â¯48, 83%) was associated with a better clinical outcome (pâ¯=â¯.003) while regurgitant volume and EROA were not. TAPSE ≤14â¯mm was associated with worse outcome (pâ¯=â¯.018). At multivariable analysis only disproportionate MR and TAPSE ≤14â¯mm showed a significant association with MACE (pâ¯=â¯.017 and pâ¯=â¯.02, respectively). A reverse left ventricular remodeling (i.e., reduction on LV end-diastolic diameter and end-diastolic volume) was achieved only in the disproportionate FMR group. CONCLUSIONS: In conclusion, disproportionate FMR assessed by regurgitant fraction and RV dysfunction assessed by TAPSE may help the selection of HF patients candidates for MitraClip therapy.