Multidetector Computed Tomography in Patients Who Underwent Transcatheter Mitral Edge-to-Edge Repair

Multidetector computed tomography (MDCT) can provide valuable information for mitral assessment, but its role in transcatheter mitral edge-to-edge repair (TEER) planning has been poorly elucidated. We aimed to compare MDCT with 3-dimensional transesophageal echocardiography (3D-TEE) for TEER preprocedural evaluation. We analyzed the prepro- cedural MDCT and 3D-TEE of 108 consecutive patients with mitral regurgitation (MR) who underwent MitraClip implantation. The levels of agreement for the etiology and mech- anism of MR, mitral calcification, mitral annulus, and mitral valve orifice area (MVOA) measurements were compared between MDCT and 3D-TEE data. Receiver-operating-char- acteristic curves were generated for mitral annulus area and MVOA using a low mean transmitral pressure gradient at discharge (<5 mm Hg) as the state variable, and the pri- mary outcome of all-cause mortality or rehospitalization for heart failure at 1 year was com- pared between MDCT's and 3D-TEE's MVOA <4-cm2 cutoff. Good levels of agreement between MDCT and 3D-TEE were observed for determining the etiology (K=0.81) and mechanism (K=0.62) of MR but not for grading mitral calcification (K=0.31 to 0.35). The correlations between MDCT and 3D-TEE measurements were strong for mitral annulus area (r=0.90) and good for MVOA (r=0.73). Furthermore, no significant differences in the area under the receiver-operating-characteristic curve to predict low transmitral pressure gradient at discharge or the primary outcome at 1 year were detected between MDCT- and 3D-TEE-derived parameters (all p >0.05). In conclusion, in patients who underwent TEER with MitraClip, a high degree of agreement for comprehensive evaluation of MR and pre- diction of clinical outcomes between MDCT and 3D-TEE was observed.(c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;208:101-110)