From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (A.S.); Davis Medical Center, University of California, Sacramento, CA (J.H.R.); Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (S.K.); Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC (M.J.R.); Cardiology Division, Terrebonne General Medical Center, Houma, LA (P.S.F.); St Vincent Heart Center of Indiana, Indianapolis, IN (J.H.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.L.W.); Division of Cardiology, Hospital of the University of Pennsylvania Medical Center, Philadelphia, PA (H.C.H.); University of Virginia, Charlottesville, VA (D.S.L.); Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA (J.R.); and Department of Surgery, Duke Department of Pediatrics, University Medical Center, Durham, NC (D.D.G.).
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Background—Percutaneous repair of mitral regurgitation (MR) permits examination of the effect of MR reduction without surgery and cardiopulmonary bypass on left ventricular (LV) dimensions and function. The goal of this analysis was to determine the extent of reverse remodeling at 12 months after successful percutaneous reduction of MR with the MitraClip device.Methods and Results—Of 64 patients with 3 and 4+ MR who achieved acute procedural success after treatment with the MitraClip device, 49 patients had moderate or less MR at 12-month follow-up. Their baseline and 12-month echocardiograms were compared between the group with and without LV dysfunction. In patients with persistent MR reduction and pre-existing LV dysfunction, there was a reduction in LV wall stress, reduced LV end-diastolic volume, LV end-systolic volume and increase in LV ejection fraction in contrast to those with normal baseline LV function, who showed reduction in LV end-diastolic volume, LV wall stress, no change in LV end-systolic volume, and a fall in LV ejection fraction.Conclusions—Patients with pre-existing LV dysfunction demonstrate reverse remodeling and improved LV ejection fraction after percutaneous mitral valve repair.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00209339, NCT00209274.