Use of Left Ventricular Global Longitudinal Strain to predict Reverse Left Ventricular Remodeling after MitraClip Repair

Abstract

Purpose: Mitral Regurgitation (MR) can cause left ventricular dilation (remodeling). Reverse remodeling describes improved volumes after intervention. Reverse remodeling carries favorable prognosis, but not all MitraClip patients undergo reverse remodeling. We hypothesized pre-procedural global longitudinal strain (preGLS) will predict reverse remodeling one-year post MitraClip in all-cause MR patients. Methods: Of the 189 MitraClips performed at our institution between 2007-2019, 57 patients had complete echocardiographic data,. Echocardiograms 0-120 days prior to and 6-24 months after procedure were retrospectively reviewed. Reverse remodeling was defined as reduction in end diastolic volume (EDV). Results: In 20 sample echocardiograms, intra and inter-reader GLS variability was r=0.95 and r=0.90, respectively. Our population consisted of 55.2% female, 12.3% functional , 61.4% degenerative and 26.3% mixed mitral regurgitation. A reduction in EDV was demonstrated in 38 patients (67%). EDV, ESV, LAVi, and RVSP significantly decreased post-clip (all p<0.01) but not LVEF. Regression models showed pre-EDV (p<0.01) and pre-ESV (p<0.01) had significant crude and adjusted linear associations and ?pre-GLS? had a significant crude curvilinear association (linear p=0.04, quadratic p =0.04) with EDV reductions post clip. The curvilinear association showed among lower, more abnormal ?pre-GLS? values, higher ?pre-GLS? was associated with greater reductions in EDV. When adjusted for pre-EDV and pre-ESV, GLS lost significance(linear p=0.29, quadratic p=0.29). Conclusion: Our study shows a majority of MitraClip patients demonstrate reverse remodeling and pre-GLS to be associated with reverse remodeling, though not robustly. A study with larger sample sizes is needed to better define the association.