Predictors of left atrial remodelling after edge-to-edge transcatheter valve repair of atrial secondary mitral regurgitation

Abstract Background Atrial secondary mitral valve regurgitation (ASMR) is a distinct anatomical subset of secondary mitral regurgitation (SMR). Evidence of the effect of transcatheter edge-to-edge repair (TEER) on left atrial (LA) anatomy and function, especially reverse remodelling (LARR), is still sparse. Methods and results We retrospectively evaluated all consecutive patients treated with TEER for mitral regurgitation (MR) in our center between January 2013 and October 2023. Of 597 patients with SMR, 103 patients (17.3%) met the inclusion criteria for ASMR. All patients in the ASMR group (mean age 79.4±6.8 years, 71% female) were symptomatic (89% NYHA≥III) and had a mean logistic EuroScore of 22.5±12.4%. TEER was successfully performed in all patients, and invasive LA mean pressures decreased intraprocedurally from 17.8±5.7 to 13.1±4.8 mmHg (p0.001). At hospital discharge, 94% of patients had mild residual or non/trace MR. At 1YFUP, the prevalence of residual moderate MR was 11% and 2% had severe MR (Figure 1A). A significant reduction in LA volume compared to baseline, both at end-systole (151.4±64 vs. 113±64 ml, p 0.001) and at end-diastole (119.8±56 vs. 91.2±56.9 ml, p0.001) could be observed (Figure 2). 70% of patients had a sustained decrease in NYHA class ≤II (Figure 1B). LARR, defined as LAESV decrease ≥15% at 1YFUP, was documented in 59% of patients. These patients were more likely to have lower postinterventional mitral valve mean pressure gradients (2.2±0.8 mmHg vs. 2.8±1.1 mmHg, p= 0.02) and lower brain natriuretic peptide (BNP) at discharge and at 1 month follow-up [319 (197.8 to 526) vs. 560 (279.3 to 929), p=0.07, and 287.5 (191.3 to 386.3) vs. 506.5 (223.3 to 935.5), p=0.06, respectively. A multivariate logistic regression analysis identified preprocedural mitral valve mean pressure gradient (p = 0.06, OR 0.92, CI 95% 0.85-1.00) and BNP at discharge (p = 0.11, OR 0.99, CI 95% 0.99-1.00) as independent predictors for the occurrence of LARR at one year. Conclusions Transcatheter mitral valve repair by edge-to-edge therapy represents a safe and effective therapeutic option in symptomatic patients with atrial secondary mitral regurgitation and might have the potential to induce left atrial reverse remodelling. Preprocedural mitral valve mean pressure gradient and BNP at discharge were identified as the only independent predictors for the occurrence of left atrial remodelling at one year.Figure 1 Figure 2