Effect of mitral valve transcatheter edge‐to‐edge repair on indices of left atrial performance in chronic mitral regurgitation

Abstract

Introduction: Effect of transcatheter edge-to-edge repair (TEER) using MitraClip in patients with mitral regurgitation (MR) on left atrial (LA) kinetic energy (LAKE), an index of LA work, and LA strain, a measure of LA performance, have not been well defined. Methods:Patients with chronic primary or secondary 3+ or 4+ MR were analyzed preand post-TEER using MitraClip. LAKE was determined by echocardiography using LA stroke volume and A-wave velocity. Peak atrial longitudinal strain (PALS), peak atrial strain in early diastole, and peak atrial contraction strain (PACS) were obtained by speckle tracking echocardiography.Results: Thirty-nine patients undergoing TEER with MitraClip were screened, 12 met criteria for analysis (9 primary and 3 secondary MR). Compared to pre-TEER, there was a significant increase post-TEER in LAKE (71.0 ± 64.1 vs. 177.5 ± 167.9 dyne⋅cm⋅10 3 , respectively; p = .008) and Doppler transmitral A-wave velocity (87.8 ± 41.4 vs.138.5 ± 43.7 cm/s, respectively; p < .001); LA stroke volume did not change significantly. Mitral valve mean gradient significantly increased post-TEER compared to pre-TEER (5.7 ± 2.1 vs. 3.3 ± 2.1 mmHg, respectively; p = .01). There was a trend toward decrease in PALS post-TEER compared to pre-TEER (16.2 ± 4.8 vs. 20.7 ± 9.9%, respectively; p = .05). Peak atrial strain in early diastole significantly decreased post-TEER compared to pre-TEER (7.2 ± 3.0 vs. 14.1 ± 7.2%; respectively, p < .001), while PACS did not significantly change (9.1 ± 3.5 vs. 6.7 ± 5.2%, respectively; p = .07). Conclusion:In patients with chronic MR, LAKE increases after TEER with MitraClip driven by an increase in LA emptying velocities. Changes were also seen in LA strain with MitraClip. These procedurally induced changes due to mild mitral stenosis may have clinical implications.

Telltale atria—The meaning of adverse remodeling

“…Improvement in other parameters, such as strain has been observed but little else has been described. 5 Dilation of the right atrium does often represent long-standing pressure and volume overload. It remains to be seen if the bi-atrial pathology corresponds with concomitant mitral and tricuspid regurgitation, simply pressure overload from singular left-sided lesions, concomitant atrial fibrillation, or just any combination of these issues.…”

“…However, unlike the electrophysiology literature, interventionalists have yet to demonstrate left atrial volume reduction or associated improved outcomes in mitral TEER. Improvement in other parameters, such as strain has been observed but little else has been described 5 …”

Atrial Cardiomyopathy in Valvular Heart Disease: From Molecular Biology to Clinical Perspectives

“…The cessation of or reduction in regurgitant volume after intervention reduce left atrial extension and pressure; however, the improvement in left atrial function might depend on preoperative strain values [ 169 ]. Improvement in atrial function after transcatheter mitral valve repair (e.g., MitraClip implantation) is controversial [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. Some study groups have found improvements in left atrial function after the transcatheter procedure; however, others have found no relevant change or even worsening [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ].…”

“…Improvement in atrial function after transcatheter mitral valve repair (e.g., MitraClip implantation) is controversial [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. Some study groups have found improvements in left atrial function after the transcatheter procedure; however, others have found no relevant change or even worsening [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. This might be due to the low study sample size and differences between study designs, including the etiology of mitral regurgitation, left ventricular function, the presence of atrial fibrillation, and the severity of residual mitral regurgitation after MitraClip implantation [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ].…”

“…Some study groups have found improvements in left atrial function after the transcatheter procedure; however, others have found no relevant change or even worsening [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. This might be due to the low study sample size and differences between study designs, including the etiology of mitral regurgitation, left ventricular function, the presence of atrial fibrillation, and the severity of residual mitral regurgitation after MitraClip implantation [ 169 , 170 , 171 , 172 , 173 , 174 , 175 ]. Avenatti et al found an improvement in atrial function after MitraClip intervention, regardless of etiology [ 173 ].…”