LAUSR

BACKGROUND Data on MitraClip procedure in patients with functional mitral regurgitation (FMR) and pulmonary hypertension (PH) are scarce. Moreover, the hemodynamic effects of MitraClip are scarcely reported. This study investigated the hemodynamic impact of MitraClip procedure in patients with heart failure with reduced left ventricular ejection fraction (HFrEF), FMR and PH; we also compared the hemodynamic changes across subgroups with different types of PH. METHODS AND RESULTS We enrolled forty-eight patients affected by FMR who consecutively underwent MitraClip and right heart catheterization (RHC) before and six months after the procedure. Compared with baseline, Mitraclip increased cardiac index (CI) (19%, p<0.001), stroke volume (SV) (24%, p=0.036) and the indices of right ventricular (RV) performance, RV power and RV work index (both 14%, p=0.02). CI improved differently according to PH group at baseline: 29.5% increase (p<0.001) in the (isolated post-capillary PH) Ipc-PH and 12.6% borderline significant increase (p=0.057) in the (combined post- and pre-capillary PH) Cpc-PH subgroup (p for interaction= 0.015); Cpc-PH patients showed a significant 25% decrease in pulmonary vascular resistance (PVR) (p for interaction =0.007). CONCLUSIONS In patients with HFrEF and significant FMR, MitraClip resulted in persistent increase in CI, SV and improvement in RV function. These favorable effects were evident in patients with PH: Ipc-PH patients showed the greatest improvement in hemodynamic profile among patients with PH; however, a consistent improvement in PVR was found in Cpc-PH patients.