Restrictive annuloplasty or replacement on reverse remodeling for nonischemic dilated cardiomyopathy

BACKGROUND

For patients with nonischemic dilated cardiomyopathy (NIDCM), the indications for and results of mitral surgery remain controversial. We reviewed a strategy of mitral repair and replacement for clinically relevant secondary mitral regurgitation (MR) in patients with NIDCM.

METHODS

We retrospectively reviewed 65 patients with advanced NIDCM (LVEF < 40%) who underwent mitral surgery. Of them, 47 (72%) underwent mitral annuloplasty and 18 (28%) replacement for secondary MR. The primary endpoint was postoperative reduction in indexed LV end-systolic volume (LVESVI).

RESULTS

At baseline, there was no intergroup difference in LVESVI (123 ± 47 vs. 147 ± 37 ml/m2, P = 0.055), LVEF (27 ± 8% vs. 25 ± 6%, P = 0.41), incidence of severe MR (57% (27/47) vs. 72% (13/18), P = 0.40), or EuroSCORE II score (6.2% vs. 7.6%, P = 0.90). At 6 months, the annuloplasty group reduced LVESVI to a greater degree than the replacement group (P < 0.001), yielding significantly smaller postoperative LVESVI (96 ± 59 vs. 154 ± 61 ml/m2, P < 0.001) and better LVEF (P < 0.001). The rates of moderate/severe recurrent MR were 17% (8/47) and 0%, respectively. Multivariable analysis demonstrated that mitral annuloplasty (OR 6.10, 95% CI 1.14-32.8, P = 0.035) was significantly associated with postoperative LV reverse remodeling. Cumulative survival was not different between the groups (P = 0.26).

CONCLUSIONS

In patients with NIDCM, mitral annuloplasty reduced LV volume to a greater degree than did mitral replacement. These findings may assist with surgical options for secondary MR associated with NIDCM.

Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to investigate whether percutaneous mitral valve repair (PMVr) using MitraClip was more effective than surgery or medical therapy for long-term morbidity and mortality. We searched MEDLINE, EMBASE, and CENTRAL (Cochrane Library) databases to identify relevant studies that recruited adult patients with functional or secondary mitral valve regurgitation who underwent PMVr with MitraClip implantation using appropriate search terms and Boolean operators. The odds ratios (ORs) were pooled using the random-effects model. A total of 14 studies recruiting 2,593 patients were included. Within 12 months of follow-up, patients who underwent PMVr did not maintain mitral valve regurgitation grade 2+ (OR 0.22, 95% confidence interval [CI] 0.12 to 0.41, p <0.0001, I2 = 0.0%, p = 0.52) or symptom-free heart failure (OR 0.47, 95% CI 0.29 to 0.77, p = 0.0028, I2 = 0.0%, p = 0.66) compared with their surgical counterparts. Patients were more likely to be rehospitalized for heart failure (OR 2.79, 95% CI 1.54 to 5.05, p = 0.0007, I2 = 0.0%, p = 0.51). However, there was no difference between the groups in terms of all-cause or cardiovascular mortality. Whereas, in comparison with medical therapy, PMVr significantly reduced all-cause mortality at 12 and ≥24 months of follow-up (OR 0.41, 95% CI 0.24, 0.69, p = 0.0009, I2 = 32%, p = 0.23 and OR 0.55, 95% CI 0.40, 0.75, p = 0.0002, I2 = 0.0%, p = 0.45, respectively). In conclusion, there was no difference in all-cause death at 12 or 24 months of follow-up between PMVr and the surgical approach, but the durability of valvular repair was inferior with PMVr. In comparison with medical therapy, there was a significant reduction in mortality with PMVr.

Outcomes and predictors of patients with moderate or severe functional mitral regurgitation and nonischemic dilated cardiomyopathy

BACKGROUND

Patients with functional mitral regurgitation (FMR) and nonischemic dilated cardiomyopathy (DCM) are associated with high mortality.

OBJECTIVES

Our study aimed to compare the clinical outcomes between different treatment strategies and identify predictors associated with the adverse outcomes.

METHODS

A total of 112 patients with moderate or severe FMR and nonischaemic DCM were included in our study. The primary composite outcome was all-cause death or unplanned hospitalization for heart failure. The secondary outcomes were individual components of the primary outcome and the cardiovascular death.

RESULTS

In this study, the primary composite outcome occurred in 26 patients (44.8%) in mitral valve repair (MVr) group and 37 patients (68.5%) in medical group (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.14-0.55; p < .001). The 1-, 3-, and 5-year survival rates for patients with MVr were 96.6%, 91.8%, and 77.4%, respectively, which were significantly higher than that of medical group: 81.2%, 71.9%, and 65.1%, respectively (HR, 0.32; 95% CI, 0.12-0.87; p = .03). Left ventricular ejection fraction (LVEF) < 41.5% (p < .001) and atrial fibrillation (p = .02) were independently associated with the primary outcome. LVEF < 41.5% (p = .007), renal insufficiency (p = .003), and left ventricular end-diastolic diameter > 66.5 mm (p < .001) were independently associated with heightened risk for all-cause death.

CONCLUSION

Compared with medical therapy, MVr was associated with a better prognosis in patients with moderate or severe FMR and nonischemic DCM. We observed that LVEF < 41.5% was the only independent predictor of the primary outcome and all individual components of secondary outcomes.

Functional anatomy and echocardiographic assessment in secondary mitral regurgitation

BACKGROUND

Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation.

AIM OF THE STUDY

The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve.

CONCLUSIONS

Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.

Relation of Myocardial Work Indexes and Forward Flow Reserve in Patients With Significant Secondary Mitral Regurgitation Undergoing Transcatheter Mitral Valve Repair

Left ventricular (LV) myocardial work (LVMW) indexes have shown incremental value over LV ejection fraction and were found to have prognostic significance in patients with secondary mitral regurgitation. We therefore aimed to investigate the association between LVMW indexes and forward flow reserve in patients with secondary mitral regurgitation, treated with transcatheter edge-to-edge repair (TEER). LVMW indexes were evaluated at baseline and forward stroke volume index (FSVI) was evaluated at baseline and 6-month follow-up after TEER. Patients were divided in 2 groups: improvers (improvement in FSVI ≥20%) and nonimprovers (improvement in FSVI <20%). A total of 70 patients (median age 76 years, 59% men) were included. FSVI was the only echocardiographic parameter that improved after TEER. There was a significant decrease in LV global longitudinal strain in the nonimprovers (p = 0.002) but not in the improvers (p = 0.177). Global work index and global constructive work worsened in nonimprovers (p = 0.005 and p = 0.004, respectively), whereas no difference was seen in these indexes in improvers (p = 0.093 and p = 0.112, respectively). Global work efficiency remained independently associated with forward flow reserve after adjusting for a variety of potential confounders. In conclusion, FSVI nonimprovers demonstrated worsening of LV systolic function after TEER compared with improvers, in whom LV systolic function remained stable. Global work efficiency was associated with FSVI improvement after TEER, independent of LV systolic function.

Comparison of cardiovascular magnetic resonance features and clinical consequences in patients with left ventricular non-compaction with and without mitral regurgitation-a multi-institutional study of the retrospective cohort study

BACKGROUND

Mitral regurgitation (MR) is common in patients with ischemic or idiopathic cardiomyopathies and may be associated with a poor prognosis; however, the impact of different degrees of MR on cardiovascular magnetic resonance images, left ventricular features, and clinical outcomes of left ventricular noncompaction are unknown. We aimed to investigate and compare cardiovascular magnetic resonance characteristics and clinical consequences in patients with left ventricular non-compaction (LVNC) with and without MR.

METHODS

A cohort of 75 patients with left ventricular noncompaction were retrospectively studied from three institutions; all had undergone cardiovascular magnetic resonance examination with subsequent clinical follow-up. MR was evaluated by echocardiography. Left ventricular myocardial strains including global radial, circumferential, and longitudinal peak strains and left ventricular geometric and functional parameters, including left ventricular ejection fraction, end-diastolic volume, end-systolic volume, left ventricular mass, left ventricular sphericity index, longitudinal shorten, and late gadolinium enhancement (LGE) were measured and compared among groups. The primary endpoint was a composite of heart transplantation, implantable cardioverter-defibrillator insertion, and cardiac death.

RESULTS

Compared with the no MR group, the MR groups showed significant deterioration in left ventricular myocardial strains (all P<0.05), and impaired left ventricular geometry and function, including lower left ventricular ejection fraction and greater left ventricular end-systolic volume and left ventricular mass (P<0.05). In the subgroup of moderate-severe MR, patients showed more impaired cardiovascular magnetic resonance features, including left ventricular sphericity index, left ventricular end-diastolic volume, and longitudinal shorten (P<0.05). In this subgroup, Kaplan-Meier analysis showed a significant difference in clinical outcomes (log-rank χ2=4.516, P=0.034; log-rank χ2=4.419, P=0.036, respectively). Additionally, multivariate analyses showed a 6.5-fold higher [hazard ratio, 6.5 (95% CI, 1.015-41.881)] risk of cardiac death with LGE in the moderate-severe MR cohort.

CONCLUSIONS

In patients with left ventricular noncompaction, MR induced more maladaptive left ventricular remodeling. The incidence of adverse outcomes may be related to the degree of MR. In moderate-severe MR patients, coexisting of LGE may have an additive deleterious effect on clinical outcomes.

MitraClip implantation in real-world: clinical relevance of different patterns of left ventricular remodeling

OBJECTIVES

The role of left ventricular (LV) volumes and ejection fraction (EF) in the selection of patients candidates to MitraClip procedure remains matter of debate. To assess the pattern of LV remodeling and its clinical implications after MitraClip procedures, and to evaluate the role of LV ejection fraction (EF) in patient selection.

METHODS

Complete echocardiography was performed before, at discharge,1,6, and 12-month in 45 patients treated with MitraClip for severe mitral regurgitation (MR) [age 78.2±8.3 yrs, NYHA 3.74±0.44, EF 36.5±12.8%]. From baseline to 6-month reverse and adverse LV-R was defined as ≥15 % decrease and ≥10% increase in LV end-systolic volume, respectively.

RESULTS

At 6-month, sustained reduction of MR≤2 was observed in all patients, but 2; reverse, adverse and no LV-R occurred in 51% (N=23), 18% (N=8) and 31% (N=14) patients. Baseline LV end-diastolic volume was an independent predictor of reverse LV-R [P=0.004], whereas EF was not. During follow-up (17.5±9.3 months), freedom from the composite endpoint (mortality and hospitalization for heart failure) was observed in 50% of adverse/no LV-R vs. 95.7% of reverse LV-R patients (P=0.006). At Cox analysis, adverse LV-R and adverse/no LV-R were associated with composite endpoint with adjusted hazard ratio of 5.6 (95% CI 1.65-19.00) and 10.08 (95% CI 1.29-78.6), respectively.

CONCLUSIONS

After MitraClip implantation, sustained adverse or no LV-R occurred in one-in-two patients and was associated with poor prognosis. Large LV volumes may help us to avoid futility of procedure.

Subannular repair for functional mitral regurgitation type IIIb in patients with ischaemic versus dilated cardiomyopathy

OBJECTIVES

Functional mitral regurgitation (FMR) is a sequel of left ventricular (LV) remodelling in heart failure patients. Relocation of both papillary muscles aims to specifically address mitral leaflet tethering to improve long-term durability of modern FMR repair. Nevertheless, the prognostic impact of the underlying cardiomyopathy on the outcome after FMR repair is unknown.

METHODS

We analysed 84 consecutive heart failure patients with severe FMR, LV ejection fraction <40%, LV end-diastolic diameter ≥55 mm and tenting height >10 mm, who underwent ring annuloplasty and simultaneous bilateral papillary muscles relocation between June 2016 and March 2019. One-year outcome of 54 patients with ischaemic cardiomyopathy ('ICM group') was prospectively compared to the remaining 30 patients with dilated cardiomyopathy ('DCM group').

RESULTS

One-year survival was similar in both groups (96% in the 'ICM group' vs 97% in the 'DCM group'; P = 0.93). Furthermore, primary composite outcome (i.e. freedom from death or mitral regurgitation ≥ 2) at 1-year postoperatively was comparable between the study groups (94%in the 'ICM group' vs 87% in the 'DCM group'; P = 0.10). LV end-diastolic diameter 1-year after surgery was significantly reduced, as compared to preoperative values, in the 'DCM group' (P = 0.018), but not in the 'ICM group' (P = 0.058). Improvement of New York Heart Association functional class and reduction of serum levels of N-terminal pro-B natriuretic peptide at 1 year was comparable in both study groups.

CONCLUSIONS

Standardized relocation of both papillary muscles to correct FMR resulted in very satisfactory in-hospital and 1-year outcomes, in both ICM and DCM. DCM patients showed similar improvement in heart failure symptoms and LV re-remodelling compared to ICM patients. Subannular repair is developing towards a valid therapeutic option in heart failure patients presenting with severe FMR.

Extent and determinants of left ventricular reverse remodeling in patients with secondary mitral regurgitation undergoing MitraClip implantation

Background

In secondary MR, data on left ventricular (LV) remodeling after MitraClip procedure are rare, even this information may impact patient selection. This study investigated changes in LV structure and function by cardiovascular magnetic resonance (CMR) following MitraClip implantation for secondary mitral regurgitation (MR) in order to assess extent and predictors of LV reverse remodeling (LVRR).

Methods and Results

Twenty-nine patients underwent CMR imaging prior to and six months after MitraClip procedure. LVRR was defined by a decrease of LV end-diastolic volume index (LVEDVi) > 15% compared to baseline. According to the definition of LVRR, 34% of patients displayed LVRR at follow-up CMR. Baseline LV stroke volume index (LVSVi), LV ejection fraction (LVEF), LV circumferential strain and MR volume at baseline were predictors of LVRR at follow-up. At second CMR, we detected an improvement in hemodynamic status as illustrated by an increase in effective LVSVi (28 ± 8 ml/m² vs. 33 ± 8 ml/m²; p = 0.053) and cardiac index (2.0 ± 0.5 vs. 2.3 ± 0.5 l/min; p = 0.016), while LVEF and LV strain parameters did not change (p > 0.05). Improvements in effective LVSVi were associated with the decrease of MR volume (r = 0.509; p = 0.018) and MR fraction (r = 0.629; p = 0.002) by MitraClip.

Conclusions

Together, MitraClip implantation is associated with LVRR in one third of patients. Baseline LV function and magnitude of MR are important predictors of LVRR. Improvement of hemodynamic status may be assessed by effective stroke volume index and correlates with the reduction of MR by MitraClip implantation, rather than an increase in LV contractility.

Left Ventricular remodeling after Mitral Valve repair and Papillary Muscle Approximation

BACKGROUND

Mitral valve repair with papillary muscle approximation (MVr-PMA) for severe secondary mitral regurgitation (MR) decreases MR recurrence compared with MVr alone. This study assessed the effects of MVr-PMA on left ventricular (LV) remodeling and shape, systolic function and strain mechanics.

METHODS

Forty-eight patients who underwent MVr-PMA for severe secondary MR and had follow-up echocardiograms available for review were identified. Student's t-test, linear regression modeling, and receiver-operating characteristic curves were used in the statistical analyses.

RESULTS

Median follow-up time was 14.9 months. MVr-PMA was associated with significant LV reverse remodeling with a smaller LV end-diastolic diameter, systolic sphericity index, and interpapillary muscle distance at follow-up. Nine patients (18.8%) experienced ≥ moderate recurrent MR. When compared recurrent MR patients at follow-up, those with durable MVr-PMA had a greater LV ejection fraction (32.8 vs 22.0%, p=0.03), a smaller end-diastolic diameter (59.6 vs 67.3 mm, p=0.03), systolic sphericity index (0.35 vs 0.47, p=0.03), and endsystolic interpapillary muscle distance (16.3 vs 21.1 mm, p=0.03). A durable MVr-PMA also resulted in stable global longitudinal strain when compared with pre-operative values, while the recurrent MR group experienced a further decline (no recurrent MR: -8.4 vs -7.5%; recurrent MR: -8.2 vs -5.4%; p<0.05). A pre-operative LV end-diastolic diameter ≥ 64 mm was a discriminative predictor of MR recurrence (sensitivity = 100%, specificity = 51%, AUC = 0.756, p = 0.02).

CONCLUSIONS

A durable MVr-PMA confers improved LV geometry and function, and stable LV mechanics. The extent of baseline LV remodeling identifies patients at risk for recurrent MR.

Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

BACKGROUND

Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR.

METHODS

A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies).

RESULTS

The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77-0.99]; p < .001) with considerable heterogeneity (I²  > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19-0.46]; p < .001) during midterm follow up. Long term survival (4-5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35-1.41]; p = .323).

CONCLUSIONS

This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.

Multimodality imaging in the diagnosis, risk stratification, and management of patients with dilated cardiomyopathies: an expert consensus document from the European Association of Cardiovascular Imaging

Dilated cardiomyopathy (DCM) is defined by the presence of left ventricular or biventricular dilatation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease sufficient to explain these changes. This is a heterogeneous disease frequently having a genetic background. Imaging is important for the diagnosis, the prognostic assessment and for guiding therapy. A multimodality imaging approach provides a comprehensive evaluation of all the issues related to this disease. The present document aims to provide recommendations for the use of multimodality imaging according to the clinical question. Selection of one or another imaging technique should be based on the clinical condition and context. Techniques are presented with the aim to underscore what is 'clinically relevant' and what are the tools that 'can be used'. There remain some gaps in evidence on the impact of multimodality imaging on the management and the treatment of DCM patients where ongoing research is important.

Long-Term Hemodynamic Improvement after Transcatheter Mitral Valve Repair

BACKGROUND

Correction of mitral regurgitation (MR) alters the load on the left ventricle. There are few data on the long-term hemodynamic adaptations of the cardiovascular system after transcatheter mitral valve repair (TMVR). The aim of this study was to determine a comprehensive hemodynamic status using noninvasive pressure-volume analysis.

METHODS

Pressure-volume parameters were calculated from echocardiography with simultaneous arm-cuff blood pressure measurements at baseline before TMVR and 12 months after TMVR. Eighty-eight consecutive patients undergoing edge-to-edge mitral clip implantation because of grade 3+ or 4+, symptomatic (79.5% in New York Heart Association functional class ≥III) MR were prospectively enrolled. The mean left ventricular (LV) ejection fraction was 42 ± 14%. Sixty-seven percent of the patients had secondary MR.

RESULTS

Twelve months after TMVR, 17.7% of patients had died, and 19.0% were rehospitalized because of decompensated heart failure. MR grade was ≤2+ in 90% of surviving patients, and 77% were in New York Heart Association functional class ≤II. LV end-diastolic volume index decreased from 87 ± 38 to 77 ± 40 mL/m² (P < .0001), end-systolic volume index changed from 54 ± 34 to 50 ± 36 mL/m² (P = .018), hence total stroke volume index was reduced (from 34 ± 11 to 28 ± 7 ml/m², P < .0001). Ejection fraction and global longitudinal peak systolic strain remained unchanged. Increased forward ejection fraction (30 ± 14% vs 41 ± 20%, P < .0001), cardiac index (from 1.7 ± 0.4 to 1.9 ± 0.5 mL/min/m², P = .003), and peak power index (214 ± 114 vs 280 ± 149 mm Hg/sec, P = .0001) as well as similar end-systolic elastance at reduced LV volumes indicated improved LV performance. Cardiac efficiency, measured as cardiac index relative to myocardial energy, was improved (0.012 ± 0.008 vs 0.019 ± 0.010 mm Hg^-1, P = .002). Logistic regression analysis revealed baseline values of total ejection fraction and diastolic pulmonary pressure gradient as predictors of clinical improvement (odds ratios, 1.076 [P = .009] and 0.812 [P = .015], respectively) after TMVR.

CONCLUSIONS

One year after TMVR, patients showed reverse remodeling and improved LV performance that was associated with improved symptom status. This hemodynamic improvement supports TMVR as long-term effective therapy for patients with symptomatic MR.

The year 2017 in the European Heart Journal-Cardiovascular Imaging: Part II

European Heart Journal - Cardiovascular Imaging was launched in 2012 as a multimodality cardiovascular imaging journal. It has gained an impressive impact factor of 8.366 during its first 5 years and is now established as one of the top 10 cardiovascular journals and has become the most important cardiovascular imaging journal in Europe. The most important studies from 2017 will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.

Galectin-3 is associated with left ventricular reverse remodeling and outcome after percutaneous mitral valve repair

BACKGROUND

Plasma Galectin-3 is a marker of myocardial inflammation and fibrosis, was associated with left ventricular (LV) reverse remodeling after conventional surgical mitral valve repair (MVR) and predicted clinical events in patients undergoing transcatheter aortic valve replacement (TAVR). We aimed to evaluate the association between pre-interventional Galectin-3 levels and (1) reverse LV remodeling and (2) major adverse cardiovascular events (MACE) in patients undergoing percutaneous MVR.

METHODS

Forty-four consecutive patients (median age 79 years, LV ejection fraction 39.5 ± 11.4%, 91% in NYHA functional class ≥III) with symptomatic moderate to severe mitral regurgitation undergoing percutaneous MVR were prospectively included. Plasma Galectin-3 levels were measured before the procedure. Echocardiographic and clinical assessment was performed at baseline and after 3 months. LV reverse remodeling was prospectively defined as a ≥10% increase in global longitudinal strain. MACE included death, myocardial infarction, heart failure related rehospitalization and stroke and was assessed after a mean follow-up time of 2 years.

RESULTS

72.7% of the patients showed LV reverse remodeling. Pre-interventional Galectin-3 < 10 ng/ml was an independent predictor of LV reverse remodeling (OR 10.3, 95% CI 1.2-83.9, p = 0.036). 25 patients (56.8%) experienced a MACE. Patients with Galectin-3 levels ≥ 10 ng/ml had significantly more MACE than patients with Galectin-3 levels < 10 ng/ml (100% vs. 45.5%, p = 0.003). Diabetes independently predicted MACE (HR 3.1, 95% CI 1.0-9.4, p = 0.049); Galectin-3 ≥ 10 ng/ml was of borderline significance (HR 2.2, 95% CI 0.9-5.4, p = 0.088).

CONCLUSIONS

Pre-interventional plasma Galectin-3 levels are associated with LV reverse remodeling and with clinical outcome after percutaneous MVR.