Mechanical effects of MitraClip on leaflet stress and myocardial strain in functional mitral regurgitation – A finite element modeling study

English version

Autoři: Yue Zhang ^aff001; Vicky Y. Wang ^aff001; Ashley E. Morgan ^aff002; Jiwon Kim ^aff003; Mark D. Handschumacher ^aff004; Chaya S. Moskowitz ^aff005; Robert A. Levine ^aff004; Liang Ge ^aff001; Julius M. Guccione ^aff001; Jonathan W. Weinsaft ^aff003; Mark B. Ratcliffe ^aff001
Působiště autorů: San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America ^aff001; Department of Surgery, University of California, San Francisco, CA, United States of America ^aff002; Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America ^aff003; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America ^aff004; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America ^aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223472

Souhrn

Purpose

MitraClip is the sole percutaneous device approved for functional mitral regurgitation (MR; FMR) but MR recurs in over one third of patients. As device-induced mechanical effects are a potential cause for MR recurrence, we tested the hypothesis that MitraClip increases leaflet stress and procedure-related strain in sub-valvular left ventricular (LV) myocardium in FMR associated with coronary disease (FMR-CAD).

Methods

Simulations were performed using finite element models of the LV + mitral valve based on MRI of 5 sheep with FMR-CAD. Models were modified to have a 20% increase in LV volume (↑LV_VOLUME) and MitraClip was simulated with contracting beam elements (virtual sutures) placed between nodes in the center edge of the anterior (AL) and posterior (PL) mitral leaflets. Effects of MitraClip on leaflet stress in the peri-MitraClip region of AL and PL, septo-lateral annular diameter (SLAD), and procedure-related radial strain (E_rr) in the sub-valvular myocardium were calculated.

Results

MitraClip increased peri-MitraClip leaflet stress at end-diastole (ED) by 22.3±7.1 kPa (p<0.0001) in AL and 14.8±1.2 kPa (p<0.0001) in PL. MitraClip decreased SLAD by 6.1±2.2 mm (p<0.0001) and increased E_rr in the sub-valvular lateral LV myocardium at ED by 0.09±0.04 (p<0.0001)). Furthermore, MitraClip in ↑LV_VOLUME was associated with persistent effects at ED but also at end-systole where peri-MitraClip leaflet stress was increased in AL by 31.9±14.4 kPa (p = 0.0268) and in PL by 22.5±23.7 kPa (p = 0.0101).

Conclusions

MitraClip for FMR-CAD increases mitral leaflet stress and radial strain in LV sub-valvular myocardium. Mechanical effects of MitraClip are augmented by LV enlargement.

Klíčová slova:

Magnetic resonance imaging – Myocardial infarction – Mechanical stress – Sheep – Myocardium – Systole – Endocardium – Diastole

Zdroje

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