{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:50:26Z","timestamp":1790891426931,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The current data on the impact of the increased mitral gradient (MG) on outcomes are ambiguous, and intraprocedural assessment of MG can be challenging. Therefore, we aimed to evaluate (a) peri\u2010interventional dynamics of MG, (b) the impact of intraprocedural MG on clinical outcomes, and (c) predictors for unfavorable MG values after MitraClip.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively included patients who underwent MitraClip. All patients underwent echocardiography at baseline, intraprocedurally, at discharge, and after 6\u00a0months. 12\u2010month survival was documented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and seventy five patients (age 81.2\u00a0\u00b1\u00a08.2\u00a0years, 61.2% male) with severe mitral regurgitation (MR) were included. We divided our cohort into two groups according to intraprocedural MG with a threshold of 4.5\u00a0mm\u00a0Hg, determined by a multivariate analysis of predictors for 12\u2010month mortality (&lt;4.5\u00a0mm\u00a0Hg: Group 1, \u22654.5\u00a0mm\u00a0Hg: Group 2).<\/jats:p><jats:p>Intraprocedural MG \u22654.5\u00a0mm\u00a0Hg was found to be the strongest independent predictor for 12\u2010month mortality (HR: 2.33, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.03, OR: 1.70, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.05), and &gt;3.9\u00a0mm\u00a0Hg was associated with adverse functional outcomes (OR: 1.96, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.04).<\/jats:p><jats:p>The baseline leaflet\u2010to\u2010annulus index &gt;1.1 was found to be the strongest independent predictor (OR: 9.74, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.001) for unfavorable intraprocedural MG, followed by the number of implanted clips (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), MG at baseline (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.02), and central clip implantation (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>An intraprocedural MG &lt;3.9\u00a0mm\u00a0Hg appears to be the best strategy for 1\u2010year survival and favorable functional outcomes after edge\u2010to\u2010edge MV repair with MitraClip independently from MR etiology. Peri\u2010interventional echocardiographic and procedural parameters are useful for the adequate assessment of intraprocedural MG.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.15126","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T14:53:57Z","timestamp":1622818437000},"page":"1115-1124","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The predictive value of intraprocedural mitral gradient for outcomes after MitraClip and its peri\u2010interventional dynamics"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5419-2488","authenticated-orcid":false,"given":"Can","family":"\u00d6zt\u00fcrk","sequence":"first","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Sprenger","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Tabata","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Sugiura","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Nickenig","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital Bonn Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schueler","sequence":"additional","affiliation":[{"name":"Contilia Heart and Vascular Center Elisabeth Hospital Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009355"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq050"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2016.1157484"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.018"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.5603\/KP.2018.0013"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(20)31936-7"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011366"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(91)90876-M"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.09.007"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2014.09.010"},{"issue":"4","key":"e_1_2_9_12_1","first-page":"145","article-title":"Percutaneous mitral valve repair with the MitraClip in primary compared with secondary mitral valve regurgitation using the mitral valve academic research consortium criteria","volume":"29","author":"Seeger J","year":"2017","journal-title":"J Invasive Cardiol"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq031"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"},{"issue":"4","key":"e_1_2_9_15_1","first-page":"431","article-title":"Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular angiography and interventions, Japanese society of echocardiography, and society for cardiovascular magnetic","volume":"32","author":"Zoghbi WA","year":"2019","journal-title":"Resonance"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.09.014"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV11SWA11"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-18-0571"},{"issue":"1","key":"e_1_2_9_19_1","first-page":"71","article-title":"MitraClip therapy for mitral regurgitation: primary mitral regurgitation","volume":"5","author":"Athappan G","year":"2016","journal-title":"Interv Cardiol 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