Prognostic Impact of Left Atrial Function Following Transcatheter Mitral Valve Repair

Abstract

Background Left atrial ( LA ) function predicts clinical outcome in a variety of cardiovascular diseases. However, limited data are available in the setting of mitral regurgitation. The aim of the present study was to assess potential changes in LA ejection fraction (LAEF) and its prognostic value in patients following transcatheter mitral valve repair using the MitraClip. Methods and Results A total of 88 consecutive patients undergoing MitraClip implantation with complete echocardiography at baseline and follow‐up between 3 and 6 months postprocedure were enrolled. LAEF improved in 58% of the population. Change in LAEF was associated with residual mitral regurgitation, residual transmitral gradient and left ventricular ejection fraction changes. Compared with their counterparts, patients with residual mitral regurgitation ≥grade 2 (change in LAEF, −6% [Interquartile [IQR], −9–1%] versus 4% [IQR, −5–15%]; P =0.05) and with residual transmitral gradient ≥5 mm Hg (change in LAEF, −2% [IQR, −9–9%] versus 5% [IQR, −4–16%]; P =0.03) showed a decline in LAEF , respectively. Furthermore, LAEF significantly correlated with changes in left ventricular ejection fraction ( r =0.40; P =0.001). With regards to clinical outcome, heart failure symptoms as assessed by New York Heart Association class were more severe in patients with worsened LAEF at follow‐up. Finally, LAEF change was identified as an independent predictor of all‐cause mortality (hazard ratio, 0.94; 95% CI, 0.90–0.98 [ P =0.008]). Conclusions The present analysis showed that changes in LA function in patients undergoing MitraClip implantation are associated with important measures including residual mitral regurgitation, elevated transmitral gradient, and left ventricular function. Importantly, LA function alterations represent a strong predictor for all‐cause mortality.

Left atrial global function in chronic heart failure patients with functional mitral regurgitation after MitraClip

“…Compared to our study, they used merely left atrial ejection fraction to assess LA function. Moreover, our patient cohort showed more impaired LV function with similar LA volumes and function 24,29. Different from DMR, diverging pathomechanisms are involved in patients with FMR: Firstly, impaired LV systolic and diastolic function.…”

“…Ledwoch et al29 showed declined LA function (ejection fraction) in 32 patients with MR after MitraClip previously. In line with our data, they showed a significant linear correlation between impaired contractile LA function and all-cause mortality.…”

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

“…Severe LA dilatation with a diameter ≥ 55 cm seems to be a highly predictive cut-off value [52] . In contrast, improvement of LA ejection fraction from baseline to short term follow up (three to six month) is associated with lower all-cause long-term mortality [53] [ Table 1].…”

“…Undoubtedly shown by a multitude of studies, impaired kidney function (defined as either reduced estimated glomerular filtration rate, elevated levels of creatinine or need of dialysis) is one of the strongest predictors for all-cause mortality in TMVr-treated patients [25,27,28,32,33,42,43,53,79,80] . Those findings are consistent in PMR, SMR and composed PMR/SMR collectives.…”

“…Reported cutoffs are ≥ 20 for logistic EuroScore and ≥ 12 for STS Score [ Table 7]. As advanced age comes along with a higher burden of comorbidities [28,62,64,80,83,86] and male patients entail a higher number of cardiac risk factors, these demographics diminish prognosis [53,78] [ Table 7].…”