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Multicenter Study
. 2024 Sep 23;17(18):2126-2137.
doi: 10.1016/j.jcin.2024.07.046.

Mismatch Between Residual Mitral Regurgitation and Left Atrial Pressure Predicts Prognosis After Transcatheter Edge-to-Edge Repair

Eiji Shibahashi  1 , Junichi Yamaguchi  2 , Takanori Kawamoto  1 , Masafumi Yoshikawa  1 , Tomohito Kogure  1 , Yusuke Inagaki  1 , Chihiro Koyanagi  1 , Hisao Otsuki  1 , Masanori Yamamoto  3 , Mike Saji  4 , Shunsuke Kubo  5 , Masahiko Asami  6 , Masaki Nakashima  7 , Yusuke Enta  7 , Shinichi Shirai  8 , Masaki Izumo  9 , Shingo Mizuno  10 , Yusuke Watanabe  11 , Makoto Amaki  12 , Kazuhisa Kodama  13 , Yoshifumi Nakajima  14 , Toru Naganuma  15 , Hiroki Bota  16 , Yohei Ohno  17 , Masahiro Yamawaki  18 , Hiroshi Ueno  19 , Kazuki Mizutani  20 , Toshiaki Otsuka  21 , Kentaro Hayashida  22 ; OCEAN-Mitral Investigators
Affiliations
Multicenter Study

Mismatch Between Residual Mitral Regurgitation and Left Atrial Pressure Predicts Prognosis After Transcatheter Edge-to-Edge Repair

Eiji Shibahashi et al. JACC Cardiovasc Interv. .

Abstract

Background: The mechanism and impact of mismatch between residual mitral regurgitation (MR) and postprocedural left atrial pressure (LAP) after transcatheter edge-to-edge repair (TEER), which may adversely affect clinical outcome, is of great interest.

Objectives: This study aimed to examine the effect of hemodynamic mismatch after TEER on clinical outcomes in patients with heart failure due to severe MR and investigate the predictive factors for the mismatch using a prospective multicenter registry.

Methods: We categorized 1,477 patients into optimal (residual MR grade ≤1 and postprocedural LAP ≤15 mm Hg), mismatched (residual MR grade >1 or postprocedural LAP >15 mm Hg), and poor (residual MR grade >1 and postprocedural LAP >15 mm Hg) groups and examined their prognosis. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.

Results: There were 927 (62.7%), 459 (31.1%), and 91 (6.2%) patients categorized into optimal, mismatched, and poor groups, respectively. Cox regression analysis, referenced to the optimal group, revealed that the mismatched and poor groups exhibited a higher risk for the primary endpoint (HR: 1.55; 95% CI: 1.28-1.88; and HR: 1.95; 95% CI: 1.38-2.74, respectively). Six risk factors were identified as predictors of hemodynamic mismatch after TEER: body mass index, baseline left atrial volume index, atrial fibrillation, tricuspid annular plane systolic excursion value, preprocedural mean left atrial pressure, and postprocedural mean mitral valve pressure gradient.

Conclusions: Post-TEER hemodynamic mismatch between residual MR and postprocedural LAP was associated with a poor prognosis. Six readily accessible perioperative parameters predict the hemodynamic mismatch. (OCEAN-Mitral registry; UMIN000023653).

Keywords: hemodynamics; left atrial pressure; mitral regurgitation; transcatheter edge-to-edge repair.

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Conflict of interest statement

Funding Support and Author Disclosures The OCEAN-Mitral registry, part of the OCEAN-SHD registry, is supported by Edwards Lifesciences, Medtronic Japan, Boston Scientific, Abbott Medical Japan, and Daiichi-Sankyo Company. Dr Yamaguchi has served as a clinical proctor of transcatheter edge-to-edge repair and received a lecture fee and scholarship donation from Abbott Medical. Drs Yamamoto and Nakajima have served as clinical proctors of transcatheter edge-to-edge repair for and received lecture fees from Abbott Medical. Drs Saji, Kubo, Izumo, Watanabe, and Amaki have served as clinical proctors of transcatheter edge-to-edge repair for and received consulting fees from Abbott Medical. Drs Asami and Kodama have received speaker fees from Abbott Medical. Drs Enta, Shirai, Mizuno, and Bota have served as clinical proctors of transcatheter edge-to-edge repair for Abbott Medical. Dr Ohno has received consulting, advisor, and speaker fees from Abbott Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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