Transesophageal Echocardiography For The Assessment of Left Atrial Pressure After Trans-Septal Mitral Valve Interventions

      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 transcatheter 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 percutaneous 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 Doppler 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 correlation 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Neuss M
        • Schau T
        • Isotani A
        • Pilz M
        • Schöpp M
        • Butter C.
        Elevated mitral valve pressure gradient after MitraClip implantation deteriorates long-term outcome in patients with severe mitral regurgitation and severe heart failure.
        JACC Cardiovasc Interv. 2017; 10: 931-939
        • Sorajja P
        • Vemulapalli S
        • Feldman T
        • Mack M
        • Holmes Jr, DR
        • Stebbins A
        • Kar S
        • Thourani V
        • Ailawadi G.
        Outcomes With transcatheter mitral valve repair in the United States: an STS/ACC TVT registry report.
        J Am Coll Cardiol. 2017; 70: 2315-2327
        • Eleid MF
        • Sanon S
        • Reeder GS
        • Suri RM
        • Rihal CS.
        Continuous left atrial pressure monitoring During MitraClip: assessing the immediate hemodynamic response.
        JACC Cardiovasc Intv. 2015; 8: e117-e119
        • Kuwata S
        • Taramasso M
        • Czopak A
        • Luciani M
        • Pozzoli A
        • Ho E
        • Ferrero Guadagnoli A
        • Saccocci M
        • Gaemperli O
        • Nietlispach F
        • Zuber M
        • Feldman T
        • Maisano F
        Continuous direct left atrial pressure: intraprocedural measurement predicts clinical response following MitraClip therapy.
        JACC Cardiovasc Intv. 2019; 12: 127-136
        • Zoghbi WA
        • Asch FM
        • Bruce C
        • Gillam LD
        • Grayburn PA
        • Hahn RT
        • Inglessis I
        • Islam AM
        • Lerakis S
        • Little SH
        • Siegel RJ
        • Skubas N
        • Slesnick TC
        • Stewart WJ
        • Thavendiranathan P
        • Weissman NJ
        • Yasukochi S
        • Zimmerman KG.
        Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Angiography and Interventions.
        J Am Soc EchocardiogrJ Am Soc Echocardiogr. 2019; 32: 431-475
        • Corrigan 3rd, FE
        • Chen JH
        • Maini A
        • Lisko JC
        • Alvarez L
        • Kamioka N
        • Reginauld S
        • Gleason PT
        • Condado JF
        • Wei JW
        • Binongo JN
        • Keegan P
        • Howell S
        • Thourani VH
        • Block PC
        • Clements SD
        • Babaliaros VC
        • Lerakis S.
        Pulmonary venous waveforms predict rehospitalization and mortality After percutaneous mitral valve repair.
        JACC Cardiovasc Imaging. 2019; 12: 1905-1913
        • Nagueh SF
        • Middleton KJ
        • Kopelen HA
        • Zoghbi WA
        • Quiñones MA.
        Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
        J Am Coll Cardiol. 1997; 30: 1527-1533
        • Park JH
        • Marwick TH.
        Use and limitations of E/e' to assess left ventricular filling pressure by echocardiography.
        J Cardiovasc Ultrasound. 2011; 19: 169-173
        • Stone GW
        • Adams DH
        • Abraham WT
        • Kappetein AP
        • Généreux P
        • Vranckx P
        • Mehran R
        • Kuck KH
        • Leon MB
        • Piazza N
        • Head SJ
        • Filippatos G
        • Vahanian AS
        • Mitral Valve Academic Research Consortium (MVARC)
        Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 2: Endpoint definitions: A consensus document From the mitral valve Academic Research Consortium.
        J Am Coll Cardiol. 2015; 66: 308-321
        • Dietl A
        • Prieschenk C
        • Eckert F
        • Birner C
        • Luchner A
        • Maier LS
        • Buchner S.
        3D vena contracta area after MitraClip© procedure: Precise quantification of residual mitral regurgitation and identification of prognostic information.
        Cardiovasc Ultrasound. 2018; 16: 1
        • Hamilton-Craig C
        • Strugnell W
        • Gaikwad N
        • Ischenko M
        • Speranza V
        • Chan J
        • Neill J
        • Platts D
        • Scalia GM
        • Burstow DJ
        • Walters DL.
        Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging.
        Ann Cardiothorac Surg. 2015; 4: 341-351
        • Taramasso M
        • Gavazzoni M
        • Kuwata S
        • Meier P
        • Maisano F.
        From color to hemodynamic assessment: is it time to change the paradigm in judging MitraClip outcomes?.
        JACC Cardiovasc Intv. 2019; 12: 151-154
        • Alkhouli M
        • Sarraf M
        • Zack CJ
        • Holmes DR
        • Rihal CS.
        Iatrogenic atrial septal defect following transseptal cardiac interventions.
        Int J Cardiol. 2016; 209: 142-148
        • Moraes DL
        • Colucci WS
        • Givertz MM.
        Secondary pulmonary hypertension in chronic heart failure: the role of the endothelium in pathophysiology and management.
        Circulation. 2000; 102: 1718-1723
        • Hong KL
        • Glover BM.
        Iatrogenic atrial septal defects After transseptal access for atrial fibrillation ablations.
        Can J Cardiol. 2019; 35: 368-369
        • Schueler R
        • Öztürk C
        • Wedekind JA
        • Werner N
        • Stöckigt F
        • Mellert F
        • Nickenig G
        • Hammerstingl C.
        Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution.
        JACC Cardiovasc Intv. 2015; 8: 450-459