"Echo-derived estimate of peak left atrial pressure in patients with iatrogenic atrial septal defects following transcatheter mitral edge-to-edge repair".

BACKGROUND

Accurate non-invasive assessment of peak left atrial pressure after transcatheter mitral edge-to-edge repair is essential for evaluating procedural success and patient outcomes. This study examined the utility of Doppler-derived transseptal flow velocity as a non-invasive method to estimate peak left atrial pressure.

METHODS

A retrospective analysis was performed in 41 patients who underwent transcatheter mitral edge-to-edge repair at a single center. Immediately after the procedure, transesophageal echocardiography was used to obtain maximum continuous-wave Doppler velocity across the iatrogenic atrial septal defect. The simplified Bernoulli equation, combined with invasively measured right atrial pressure, was applied to calculate Doppler-derived peak left atrial pressure. Invasively measured peak left atrial pressure served as the reference standard.

RESULTS

The median invasive peak left atrial pressure following the procedure was 15 mmHg (interquartile range, 12-20), while the median Doppler-derived peak left atrial pressure was 14 mmHg (interquartile range, 12-18). Doppler-derived estimates demonstrated a strong correlation with invasive measurements (correlation coefficient = 0.90), whereas peak Doppler velocity alone showed only a moderate correlation (correlation coefficient = 0.61). Lin's concordance correlation coefficient demonstrated strong agreement (0.86; 95 % confidence interval, 0.73-0.95). Bland-Altman analysis demonstrated a mean bias of - 1.54 mmHg, with narrow limits of agreement (-6.2 to + 3.1).

CONCLUSIONS

Doppler-derived assessment of transseptal flow provides a practical and accurate non-invasive method for estimating peak left atrial pressure after transcatheter mitral edge-to-edge repair. This approach may augment current post-procedural evaluation strategies and support clinical decision-making in the management of patients undergoing mitral valve intervention.