Correlates and Prognostic Implications of LVEF Reduction After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation

Alon Shechter; Danon Kaewkes; Mirae Lee; Moody Makar; Vivek Patel; Ofir Koren; Keita Koseki; Takashi Nagasaka; Sabah Skaf; Tarun Chakravarty; Raj R Makkar; Robert J Siegel

doi:10.1093/ehjci/jead210

Correlates and Prognostic Implications of LVEF Reduction After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation

Eur Heart J Cardiovasc Imaging. 2023 Aug 17:jead210. doi: 10.1093/ehjci/jead210. Online ahead of print.

Authors

Alon Shechter^{1

2

3}, Danon Kaewkes^{1

4}, Mirae Lee^{1

5}, Moody Makar¹, Vivek Patel¹, Ofir Koren^{1

6}, Keita Koseki^{1

7}, Takashi Nagasaka^{1

8}, Sabah Skaf¹, Tarun Chakravarty¹, Raj R Makkar¹, Robert J Siegel^{1

9}

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
² Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
³ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand.
⁵ Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea.
⁶ Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
⁷ Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
⁸ Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
⁹ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

PMID: 37590951
DOI: 10.1093/ehjci/jead210

Abstract

Aims: To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure.

Methods and results: We retrospectively analyzed 317 individuals (median age 83 (IQR, 75-88) years, 197 (62.1%) males) treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared to baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While postprocedural MR, transmitral mean pressure gradient, and functional status were comparable in the 2 study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs 5.7%, p = 0.019), be readmitted for HF (17.1% vs 9.0%, p = 0.033), and experience either of the two (23.8% vs 12.7%, p = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, p = 0.016).

Conclusion: LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.

Keywords: Left ventricular ejection fraction; MitraClip; Mitral regurgitation; Mitral transcatheter edge-to-edge repair; Transcatheter mitral valve repair.