Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2026
Quantitative Three-Dimensional Transesophageal Echocardiography Analysis of Mitral Valve Geometry for Transcatheter Edge-to-Edge Repair Strategy in Atrial Functional Mitral Regurgitation.
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Huang Kuan-Chih, Thaden Jeremy J, Saleh Ghasaq, Al-Halaseh Salameh, Chang Shih-Sheng, Alkhouli Mohamad
Аннотация
BACKGROUND: Atrial functional mitral regurgitation (AFMR) is a distinct subtype of secondary mitral regurgitation (MR) in patients with atrial fibrillation (AF). Although mitral transcatheter edge-to-edge repair (M-TEER) is increasingly performed under three-dimensional (3D) transesophageal echocardiography (TEE) guidance, detailed characterization of 3D mitral valve geometry relevant to procedural strategy remains limited.
OBJECTIVES: To investigate the impact of mitral valve geometrical parameters on preprocedural planning and outcomes of M-TEER in AFMR.
METHODS: Patients with AFMR undergoing M-TEER with analyzable intraprocedural 3D TEE data were retrospectively enrolled. We evaluated whether the total leaflet area to mitral annulus area ratio (TLA/MAA) was associated with procedural strategy (1 vs 2 devices) and procedural failure, defined as residual MR ≥ 2+ and/or postprocedural transmitral mean pressure gradient (MPG) ≥ 5 mm Hg.
RESULTS: Among 130 patients (mean age, 78.1 years; 60.8% male; 93.4% AF), residual MR ≥ 2+ occurred in 31 patients and post-M-TEER MPG ≥ 5 mm Hg in 35 patients. Thirty patients received 2 devices. Lower TLA/MAA was associated with residual MR ≥ 2+, use of 2 devices, and postprocedural MPG ≥ 5 mm Hg. Under the composite definition of procedural success (MR < 2+ and MPG < 5 mm Hg), TLA/MAA outperformed MAA in predicting success with 1 device (area under the curve = 0.79 vs 0.53; P < .001).
CONCLUSIONS: In AFMR, 3D TEE-derived TLA/MAA can provide geometrical information to guide preprocedural M-TEER strategy to balance MR reduction and transmitral gradient.
OBJECTIVES: To investigate the impact of mitral valve geometrical parameters on preprocedural planning and outcomes of M-TEER in AFMR.
METHODS: Patients with AFMR undergoing M-TEER with analyzable intraprocedural 3D TEE data were retrospectively enrolled. We evaluated whether the total leaflet area to mitral annulus area ratio (TLA/MAA) was associated with procedural strategy (1 vs 2 devices) and procedural failure, defined as residual MR ≥ 2+ and/or postprocedural transmitral mean pressure gradient (MPG) ≥ 5 mm Hg.
RESULTS: Among 130 patients (mean age, 78.1 years; 60.8% male; 93.4% AF), residual MR ≥ 2+ occurred in 31 patients and post-M-TEER MPG ≥ 5 mm Hg in 35 patients. Thirty patients received 2 devices. Lower TLA/MAA was associated with residual MR ≥ 2+, use of 2 devices, and postprocedural MPG ≥ 5 mm Hg. Under the composite definition of procedural success (MR < 2+ and MPG < 5 mm Hg), TLA/MAA outperformed MAA in predicting success with 1 device (area under the curve = 0.79 vs 0.53; P < .001).
CONCLUSIONS: In AFMR, 3D TEE-derived TLA/MAA can provide geometrical information to guide preprocedural M-TEER strategy to balance MR reduction and transmitral gradient.