Left Ventricular Function and Atrial Remodeling Shape Outcomes After Mitral-Transcatheter Edge-to-Edge Repair
Abstract
Background: Secondary mitral regurgitation (SMR) contributes substantially to morbidity and mortality in heart failure. Mitral transcatheter edge-to-edge repair (M-TEER) improves outcomes in patients with reduced left ventricular ejection fraction (LVEF), but evidence in patients with preserved LVEF-often reflecting atrial functional mitral regurgitation-remains limited. Methods: We retrospectively analyzed 93 consecutive patients with symptomatic SMR treated with M-TEER between 2018 and 2022. Patients were stratified according to LVEF (<50% vs ≥50%) and left atrial volume index (LAVI <60 vs ≥60 mL/m2). The primary endpoint was comprehensive clinical improvement at 36 months, defined as survival without heart-failure hospitalization, New York Heart Association (NYHA) class I-II, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score >60. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: Among 87 patients with complete follow-up, 48 (55%) achieved the composite endpoint. Clinical improvement rates were similar in patients with reduced and preserved LVEF (51.8% vs 62.5%, p=0.32). All-cause mortality at 36 months was lower in preserved compared with reduced LVEF (9.4% vs 29.6%; log-rank p=0.03). Enlarged left atrial volume (LAVI ≥60 mL/m2) was associated with increased mortality (29.4% vs 11.8%; log-rank p=0.04). In Cox regression analyses adjusted for age and sex, LAVI remained associated with mortality risk. Conclusion: M-TEER provides sustained clinical benefit across the LVEF spectrum, including patients with preserved LVEF. Left atrial enlargement identifies patients with worse prognosis and may represent a marker of advanced atrial disease supporting earlier intervention.
Related
- Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation
- Sustained 10% Oxygen Promotes Atrial Rather Than Ventricular Specification During Human iPSC-Cardiomyocyte Differentiation
- Left atrial remodelling and diastolic unloading after transcatheter tricuspid repair
- From marrow memory to adverse ventricular remodeling: trained immunity after myocardial infarction
- Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry
BibTeX
@article{rouleau2026left,
title = {{Left Ventricular Function and Atrial Remodeling Shape Outcomes After Mitral-Transcatheter Edge-to-Edge Repair}},
author = {Louise Rouleau and Marina Petersen Saadi and Adrien Al Wazzan and Prayuth Rasmeehirun and Guillaume L'Official and Vincent Auffret and Guillaume Leurent and Emmanuel Oger and Erwan Donal},
journal = {ESC Heart Failure},
year = {2026},
month = oct,
doi = {10.1093/eschf/xvag149},
url = {https://hal.science/hal-05648193v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Left Ventricular Function and Atrial Remodeling Shape Outcomes After Mitral-Transcatheter Edge-to-Edge Repair
AU - Louise Rouleau
AU - Marina Petersen Saadi
AU - Adrien Al Wazzan
AU - Prayuth Rasmeehirun
AU - Guillaume L'Official
AU - Vincent Auffret
AU - Guillaume Leurent
AU - Emmanuel Oger
AU - Erwan Donal
PY - 2026
DA - 2026/10/13
JO - ESC Heart Failure
DO - 10.1093/eschf/xvag149
UR - https://hal.science/hal-05648193v1
AB - Background: Secondary mitral regurgitation (SMR) contributes substantially to morbidity and mortality in heart failure. Mitral transcatheter edge-to-edge repair (M-TEER) improves outcomes in patients with reduced left ventricular ejection fraction (LVEF), but evidence in patients with preserved LVEF-often reflecting atrial functional mitral regurgitation-remains limited. Methods: We retrospectively analyzed 93 consecutive patients with symptomatic SMR treated with M-TEER between 2018 and 2022. Patients were stratified according to LVEF (<50% vs ≥50%) and left atrial volume index (LAVI <60 vs ≥60 mL/m2). The primary endpoint was comprehensive clinical improvement at 36 months, defined as survival without heart-failure hospitalization, New York Heart Association (NYHA) class I-II, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score >60. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: Among 87 patients with complete follow-up, 48 (55%) achieved the composite endpoint. Clinical improvement rates were similar in patients with reduced and preserved LVEF (51.8% vs 62.5%, p=0.32). All-cause mortality at 36 months was lower in preserved compared with reduced LVEF (9.4% vs 29.6%; log-rank p=0.03). Enlarged left atrial volume (LAVI ≥60 mL/m2) was associated with increased mortality (29.4% vs 11.8%; log-rank p=0.04). In Cox regression analyses adjusted for age and sex, LAVI remained associated with mortality risk. Conclusion: M-TEER provides sustained clinical benefit across the LVEF spectrum, including patients with preserved LVEF. Left atrial enlargement identifies patients with worse prognosis and may represent a marker of advanced atrial disease supporting earlier intervention.
SN - 2055-5822
ER -