Echocardiographic Indices of Cardiac Remodeling Following Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis.

BACKGROUND

Secondary mitral regurgitation is associated with adverse clinical outcomes and cardiac remodeling. While transcatheter edge-to-edge repair (TEER) improves symptoms and prognosis in selected patients, its effects on cardiac remodeling remain debated. This systematic review and meta-analysis aimed to evaluate the impact of TEER on echocardiographic indices of cardiac remodeling.

METHODS

PubMed, Scopus, and Cochrane Library were used to identify relevant studies assessing echocardiographic changes before and after TEER. Outcomes of interest were left ventricular (LV) ejection fraction, global longitudinal strain, LV end-diastolic and end-systolic volumes and LV end-diastolic and end-systolic diameter, tricuspid annular plane systolic excursion, pulmonary artery systolic pressure, and left atrial end-systolic volume.

RESULTS

Forty-two studies (3987 patients) were included. TEER was associated with a significant increase in LV ejection fraction (mean difference [MD], 1.51% [95% CI, 0.47-2.55]), without significant improvement in global longitudinal strain. Significant LV remodeling was observed, with reductions in LV end-diastolic volume (standardized MD, -0.26 [95% CI, -0.37 to -0.14]), LV end-systolic volume (standardized MD, -0.21 [95% CI, -0.30 to -0.12]), LV end-diastolic diameter (MD, -2.35 mm [95% CI, -3.66 to -1.04]) and left ventricular end-systolic diameter (MD, -2.30 mm [95% CI, -3.86 to -0.74). TEER also improved right ventricular function (tricuspid annular plane systolic excursion [MD, 1.29 mm [95% CI, 0.60-1.97]) and reduced pulmonary artery systolic pressure (MD, -6.75 mm Hg [95% CI, -8.53 to -4.97). No significant improvement in left atrial end-systolic volume was detected.

CONCLUSIONS

Available evidence suggests that TEER promotes significant cardiac remodeling in patients with secondary mitral regurgitation.