Optimal CW-Doppler derived parameter for the diagnosis of iatrogenic mitral stenosis during transcatheter edge-to-edge repair for mitral regurgitation

Abstract Introduction Transcatheter Edge-to-Edge repair (TEER) for mitral regurgitation (MR) is a minimal invasive alternative to surgery high risk patients. One of the principal disadvantage creating stenosis (MS). The optimal parameter and its cut-off monitor valve area (MVA) during TEER currently not defined usually only mean transmitral gradient (Gd) used. Method 116 patients with complete 3D MVA measurements CW-Doppler derived maximal diastolic Gd, pressure half time (PHT) before intervention after each device implantation were included in this study. A clinically significant MS was as <1.5 cm2 according ESC guidelines. Because Gd known be extremely dependent on heart rate (HR) “normalized” frequency 60/min: norm. = (mean Gd/HR) × 60. accuracy different CW-derived parameters diagnose or predict evaluated using ROC analysis. Results 47% suffered from secondary MR, 53% treated one two. According measurements, 16 two devices 12 had MS. analyses diagnosis (Figure 1) show AUC 0.99 PHT an 151ms (sensitivity 94%, specificity 95%), followed by (AUC 0.96, 3.16mmHg, 100%, 82%), 0.92, 3.6mmHg, 88%, 83%) max. 8.5mmHg, 83%). Combining three cut-offs (PHT 164ms 4.7mmHg 12mmHg) sensitivity 100% 98% achieved. prognostic value these same much less analyses: PHT, 0.82, 100ms, 83%, 59%; 0.73, 2.8mmHg, 67%, 81%; 0.70, 2.4mmHg, 51%; 0.69, 8.4mmHg, 50%, 85%. diagnostic measured detect better 2): 142ms, 92%, 78%; 0.87, 3.4mmHg, 73%; 0.81, 3.9mmHg, 71%; 0.74, 8.6mmHg, 66%. without false negative were: 140ms (specificity 86%) device, 93ms 56%) second 133ms 63%) devices. Conclusion most accurate make TEER. Given possible disastrous consequence iatrogenic stenosis, should used offering when above limits measured, then decisions based measurements. Funding Acknowledgement Type funding sources: None.