Mitral Transcatheter Edge-to-Edge Repair and Clinical Value of Novel Echocardiographic Biomarkers: A Hypothesis-Generating Study

• Published in: Biomedicines Vol. 12; no. 8; p. 1710
• Main Authors: Solsona-Caravaca, Javier, Fernández-Galera, Rubén, González-Fernández, Víctor, Airale, Lorenzo, Rivas, Johny, Scudeler, Luca, Vallejo, Núria, Teixidó-Turà, Gisela, Casas, Guillem, Valente, Filipa, Oliveró, Ruper, Belahnech, Yassin, Martí, Gerard, García, Bruno, Ferreira-González, Ignacio, Rodríguez-Palomares, José F, Galian-Gay, Laura
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.08.2024; MDPI
• Subjects: Analysis; Biological markers; Biomarkers; Blood pressure; Cardiac arrhythmia; Cardiology; cardiovascular death; Cardiovascular disease; Care and treatment; Congestive heart failure; Diagnosis; Echocardiography; Evaluation; Heart failure; heart failure hospitalization; Hospitalization; Hypotheses; Medical prognosis; mitral regurgitation; Mitral valve insufficiency; myocardial work; Pulmonary arteries; Pulmonary artery; Regurgitation; Risk groups; Statistical analysis; transcatheter edge-to-edge repair; Ventricle; ventricle–pulmonary artery coupling; Spain
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines12081710

Background: Longitudinal data on reverse cardiac remodeling and outcomes after transcatheter edge-to-edge repair (TEER) are limited. Methods: A total of 78 patients with severe mitral regurgitation (MR) were included retrospectively. All patients had echocardiography at baseline and again six months after TEER. They were monitored for a primary composite endpoint, consisting of heart failure hospitalization and cardiovascular death, over 13 months. Results: Significant decreases in the left ventricular ejection fraction (LVEF), all myocardial work indices (except global wasted work), and the left atrial reservoir were observed after TEER. Additionally, there was a decrease in the pulmonary artery systolic pressure and an increase in the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio. A post-TEER TAPSE/PASP ratio of <0.47 (HR: 4.76, p-value = 0.039), and a post-TEER left atrial reservoir of <9.0% (HR: 2.77, p-value = 0.047) were associated with the primary endpoint. Conclusions: Echocardiography post-TEER reflects impairment in ventricular performance due to preload reduction and right ventricle and pulmonary artery coupling improvement. Short-term echocardiography after TEER identifies high-risk patients who could benefit from a close clinical follow-up. The prognostic significance of LA strain and the TAPSE/PASP ratio should be validated in subsequent large-scale prospective studies.