Preprocedural Three-Dimensional Vena Contracta Area in Ventricular Secondary Mitral Regurgitation: Association with Outcome after Mitral Valve Intervention

OBJECTIVE: Increasing effective regurgitant orifice area (EROA) has been associated with poor outcomes in patients with ventricular secondary mitral regurgitation (VSMR). However, measuring EROA with two-dimensional (2D) echocardiography has important limitations. Overcoming most of these limitations, three-dimensional (3D) color Doppler transesophageal echocardiography allows direct assessment of the vena contracta area (VCA), whose prognostic value, however, has not been specifically investigated in patients with VSMR undergoing mitral valve intervention. METHODS: A total of 218 patients (69% men, median age 74 years) with significant VSMR undergoing either transcatheter edge-to-edge repair or mitral valve surgery were retrospectively analyzed. Three-dimensional VCA was measured before intervention, and patients were followed up for the combined end point of all-cause mortality or heart failure hospitalization. RESULTS: Of the total population, 63% of patients had ischemic heart disease, 60% had atrial fibrillation, and 25% received cardiac resynchronization therapy. During a median follow-up of 28 months, 130 (60%) patients met the combined end point (101 died and 81 were hospitalized due to heart failure). According to receiver operating characteristic analysis, a cutoff value of 3D-VCA ≥50 mm² was associated with increased risk of the combined end point. In a multivariable Cox regression analysis, 3D-VCA ≥ 50 mm2 remained independently associated with the composite end point (hazard ratio = 1.466; 95% CI, 1.019-2.109; P = .039) after correcting for important covariates, including left ventricular remodeling, symptoms, and residual mitral regurgitation after intervention. Two-dimensional EROA instead was not associated with the study outcome. CONCLUSION: In patients with VSMR undergoing mitral valve intervention, a preprocedural 3D-VCA may help risk stratification compared with standard 2D echocardiographic measures of MR severity.