Temporal Trends in Left and Right Heart Remodeling Following Transcatheter Edge-to-Edge Mitral Repair for Degenerative Mitral Regurgitation

Mitral regurgitation (MR) is the most commonly encountered valvular heart disease in United States and increases with age.1Nkomo VT Gardin JM Skelton TN Gottdiener JS Scott CG Enriquez-Sarano M Burden of diseases: a population-based study.Lancet. 2006; 368 (doi:10.1016/S0140-6736(06)69208-8.): 1005-1011Google Scholar There are two broad categories: degenerative mitral (DMR), caused by myxomatous leading to leaflet prolapse/flail; functional (FMR), typically left ventricular (LV) dilation. Transcatheter edge-to-edge repair (TEER) MitraClip (Abbott Laboratories, USA) has been established as treatment for DMR high-risk patients.2Feldman T Foster E Glower DD et al.Percutaneous or surgery regurgitation.N Engl J Med. 2011; 364 (doi:10.1056/NEJMoa1009355.): 1395-1406Google Few studies have looked at myocardial remodeling patients. Our primary objective was assess how LV global longitudinal strain (GLS), right free wall (RV FWS), atrial reservoir (LARS) change 12 months post-TEER. secondary compare these parameters differed normal sinus rhythm (NSR) fibrillation (AF). This retrospective study individuals undergoing TEER 3–4+ between July 2014 February 2020. The IRB approved. Analysis transthoracic echocardiograms (TTE) performed an experienced reader per ASE guidelines. MR quantified proximal isovelocity surface area method. Simpson’s method discs used derive ejection fraction (LVEF). Strain analysis TOMTEC (Munich, Germany). Patients were excluded if they had inadequate acoustic windows, poor endomyocardial tracking, echocardiogram (ECG) gating. Descriptive statistics calculated continuous variables expressed mean standard deviation (SD) median interquartile range (IQR) appropriate based on data distributions. A total 121 patients underwent our institution during period. Seventy-one (59%) included. due following reasons: 39 (32%) incomplete echocardiographic (follow-up referring hospital), 4 (3%) prior surgical MV repair, 5 (4%) procedural failure (3 single attachment, 2 required valve (MV) replacement), (2%) paced indeterminate underlying rhythm. age 84 (78–86) years, 32 (45%) female, 29 (41%) AF. Society Thoracic Surgeons (STS) score 5.9% (4.0–9.0%). Fifty-six percent one clip placed, 41% clips 3% three. Post-TEER, severity reduced from 100% 91% 0–2 months. New York Heart Association improved 87% class III–IV only 28% symptoms volumes decreased post-TEER entire cohort (LV end-diastolic volume [EDV] 117 ± 53 94 35 mL; end-systolic [ESV] 49 28 42 20 mL). LVESV higher AF compared NSR (Figure 1A, B). LVEF modestly 59 10% 56 8% baseline but greater those vs. 1C). Forward EF stroke determined outflow tract pulsed Doppler method/LVEDV) both 1D). GLS remained stable over time worse among all points 1E). Left index (LAVI) 54 (43–68) 46 (37–73) mL/m2 subjects. LAVI subjects 1F) did not improve. LA unchanged; 16.3 8.2% versus 16.9 8.5% RV fractional FAC) (36.7 5.0% 40.4 6.5% months) improve 1G). Similarly, FWS (−20.6 4.6% −24.1 5.4%) 1H). In percutaneous DMR, potentially stabilizing effect parameters. We observed (1) reduction accompanied improvement effective LVEF; (2) months; (3) FAC (and NSR). Previous work post-TEER.3Grayburn PA Sangli C al.Relationship magnitude reverse after therapy.Circulation. 2013; 128 (doi:10.1161/CIRCULATIONAHA.112.001039.): 1667-1674Google To knowledge, we first report impact DMR. cohort, resulted initial decline 1 month then stabilized Those found NSR. shown that risk factor deterioration DMR.4Witkowski TG Thomas JD Debonnaire PJMR al.Global predicts dysfunction repair.Eur Cardiovasc Imaging. 2012; 14 (doi:10.1093/ehjci/jes155.): 69-76Google Temporal trends reported. FWS, predominantly highlights complex interplay heart. while not, which may suggest RV, NSR, able remodel more so than LV. Gucuk al. reported LARS ≤2+ residual worsened >2+ months.5Gucuk Ipek Singh S Viloria al.Impact procedure rate.Circulation. 2018; 11: e006553Google find LARS. Subjects Lack despite volume, primarily reflect degree irreversible fibrosis chronic MR. likely compounded adverse limited its nature sample size. While prolapse/flail pathology, some also component Finally, there no control group. largest population. led volumes, forward EF, stabilizes GLS. Additionally, positive demonstrated These results hypothesis generating. Further research necessary corroborate findings.