Journal of cardiovascular medicine (Hagerstown, Md.) · 2026
Prevalence and prognostic role of left atrial reverse remodeling in patients undergoing mitral transcatheter edge-to-edge repair: insights from the Multicenter Echocardiographic Registry of patients undergoing mitral Transcatheter Edge-to-Edge Repair.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Pezzola Elisa, Lupi Laura, Rubbio Antonio Popolo, Sciatti Edoardo, Giannini Cristina, Barletta Marta, De Luca Antonio, Stolfo Davide, Serafini Lisa, Ricci Alessandra, Fiocca Luigi, Mazzola Matteo, Branca Luca, Massussi Mauro, Senni Michele, Sinagra Gianfranco, Bedogni Francesco, De Carlo Marco, Metra Marco, Adamo Marianna
Аннотация
AIMS: Atrial enlargement is a complex maladaptive process related to pressure and volume overload. Left atrial reverse remodeling (LARR) has been described as a result of medical and interventional therapies. We sought to explore LARR prevalence and its prognostic implications following mitral transcatheter edge-to-edge repair (M-TEER).
METHODS AND RESULTS: Four-hundred and twenty-five patients from the MERIT-TEER (Multicenter Echocardiographic Registry of patients undergoing M-TEER) who received a successful procedure from 2012 to 2024 with available left atrial volume (LAV) have been analyzed. LARR was defined as a reduction in LAV of at least 15%. LARR prevalence and its association with the risk of heart failure hospitalization and all-cause mortality at 4 years' follow-up were evaluated in the overall population and according to mitral regurgitation etiology.At short-term follow-up, LARR was observed in 124 patients (29.20%). LARR was more prevalent among primary mitral regurgitation (PMR) patients compared with those with ventricular secondary (vSMR) and atrial secondary mitral regurgitation (aSMR) (37.23, 27.19, and 18.33%; P = 0.017). At long-term follow-up, the composite outcome occurred in 153 patients (36.2%). LARR was independently associated with lower risk of events in the overall population [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.43-0.85, P = 0.005] and among vSMR patients (adjusted hazard ratio 0.43, 95% CI 0.26-0.71, P = 0.001), but not in aSMR or PMR.
CONCLUSION: LARR was observed in less than one-third of patients undergoing M-TEER (29.2%), occurring more frequently in PMR. LARR was independently associated with lower risk of all-cause mortality and heart failure hospitalization in the overall population and particularly in patients with vSMR.
METHODS AND RESULTS: Four-hundred and twenty-five patients from the MERIT-TEER (Multicenter Echocardiographic Registry of patients undergoing M-TEER) who received a successful procedure from 2012 to 2024 with available left atrial volume (LAV) have been analyzed. LARR was defined as a reduction in LAV of at least 15%. LARR prevalence and its association with the risk of heart failure hospitalization and all-cause mortality at 4 years' follow-up were evaluated in the overall population and according to mitral regurgitation etiology.At short-term follow-up, LARR was observed in 124 patients (29.20%). LARR was more prevalent among primary mitral regurgitation (PMR) patients compared with those with ventricular secondary (vSMR) and atrial secondary mitral regurgitation (aSMR) (37.23, 27.19, and 18.33%; P = 0.017). At long-term follow-up, the composite outcome occurred in 153 patients (36.2%). LARR was independently associated with lower risk of events in the overall population [adjusted hazard ratio 0.59, 95% confidence interval (CI) 0.43-0.85, P = 0.005] and among vSMR patients (adjusted hazard ratio 0.43, 95% CI 0.26-0.71, P = 0.001), but not in aSMR or PMR.
CONCLUSION: LARR was observed in less than one-third of patients undergoing M-TEER (29.2%), occurring more frequently in PMR. LARR was independently associated with lower risk of all-cause mortality and heart failure hospitalization in the overall population and particularly in patients with vSMR.