This is a multi-center, prospective, observational study designed to evaluate the impact of LV myocardial fibrosis extent assessed by CMR on LV reverse remodeling and clinical outcomes post TEER. The target sample will be up to 125 patients enrolled to achieve 100 evaluable at 6 months of follow-up. Enrollment will occur at up to eight centers.
Patients undergoing guideline-directed TEER with FDA-approved MitraClip at the participating centers will be screened and recruited for study participation. After informed consent is obtained, patients will undergo a clinically-indicated baseline CMR study with gadolinium up to 90 days before TEER procedure. In addition, a quality-of-life surveillance questionnaire (KCCQ) will be completed at the same baseline visit. Six months after TEER patients will return to clinic to repeat the quality of life surveillance questionnaire (KCCQ), the CMR study and a transthoracic echocardiogram. The 6-month CMR study and echocardiogram should be completed on the same day or no greater than 30 days apart if the same day is not feasible. Blood samples will be collected on the day of the CMR to provide the hematocrit for ECV calculation. These samples are done as standard clinical care. Electronic Health Records (EHR) will be reviewed and phone contact performed yearly for up to three years after TEER to evaluate clinical outcomes (heart failure hospitalization, outpatient use of intravenous inotropes, LVAD implant, heart transplant, or death).
Study Type
OBSERVATIONAL
Enrollment
125
Clinically indicated baseline CMR study with contrast up to 90 days before TEER procedure, including KCCQ questionnaire. At 6 months, participants will return for repeat of KCCQ, CMR study and a transthoracic echocardiogram. Blood samples, done as standard clinical care for hemotocrit for ECV calculation, will be obtained.
Minneapolis Heart Institute Foundation
Minneapolis, Minnesota, United States
RECRUITINGSanger Heart and Vascular Institute
Charlotte, North Carolina, United States
ENROLLING_BY_INVITATIONThe Christ Hospital Health Network
Cincinnati, Ohio, United States
Estimate the association between LV myocardial fibrosis by CMR late gadolinium enhancement imaging before TEER with LV reverse remodeling.
change in LV end-diastolic volume index \[LVEDVi\] 6 months after TEER
Time frame: From enrollment to the end of 6 months
Estimate the association of the ratio between CMR-based mitral regurgitant volume (RegVol) and LV end-diastolic volume (LVEDV)-RegVol/LVEDV-with LV reverse remodeling;
Reg/Vol and LVEDV with LV reverse remodeling
Time frame: Enrollment to the end of 6 months
Evaluate the interaction between CMR-based mitral regurgitation quantification (RegVol and regurgitant fraction) with LV myocardial fibrosis extent, and its association with LV reverse remodeling
RegVol and regurgitant fraction with LV myocardial fibrosis extent
Time frame: Enrollment to the end of 6 months
Estimate the association between LV extracellular volume (ECV) by CMR T1 mapping before TEER with LV reverse remodeling
ECV before TEER with LV reverse remodeling
Time frame: Enrollment to the end of 6 months
Estimate the association of LV myocardial fibrosis extent and a combined endpoint including all-cause death, heart failure hospitalization, cardiac transplant and LVAD implant;
LV myocardial fibrosis and endpoint data points (all cause death, heart failure hospitalization, cardiac transplant and LVAD implant)
Time frame: Enrollment to the end of 6 months
Estimate the association of LV myocardial fibrosis extent and the change in quality-of-life (Kansas City Cardiomyopathy Questionnaire [KCCQ]) post TEER
LV myocardial extent and % of change in quality of life KCCQ
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Cleveland Clinic
Cleveland, Ohio, United States
ENROLLING_BY_INVITATIONInova Fairfax Medical Campus
Falls Church, Virginia, United States
ENROLLING_BY_INVITATIONIRCCS Ospedale San Raffaele
Milan, Italy
ENROLLING_BY_INVITATIONTime frame: Enrollment to the end of 6 months
Estimate the intermodality agreement of residual MR between 3D echo and CMR at 6 months post-TEER
Intermodality agreement of residential agreement in echo and CMR
Time frame: Enrollment through 6 months