Increased Afterload in Patients With Acute Reduction in Left Ventricular Ejection Fraction Following Mitral Valve Transcatheter Edge-to-Edge Repair

Abstract

Aim

The mechanisms and clinical importance of acute reduction (ARD) in left ventricular (LV) function following transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) remains unclear. This study aimed to non-invasively evaluate the cardio-mechanical parameters, including end-systolic elastance (Ees) and arterial elastance (Ea), to explore their association with ARD following mitral TEER.

Methods and Results

We performed a retrospective analysis of serial transthoracic echocardiography (TTE) studies before and after mitral TEER. Cardio-mechanical parameters were evaluated non-invasively using a modified single-beat method. After the exclusion of nine patients requiring intravenous catecholamine infusion, the study cohort comprised 49 consecutive patients (25 men; mean age: 81 ± 9 years) with successful mitral TEER. ARD in LV function was defined as a decrease in LV ejection fraction (LVEF) of ≥5 points following the procedure by TTE, which was reported in 18 patients. The hospitalization period was longer in patients with ARD in LVEF than in those without ARD (5.5 days vs. 4 days, p = 0.031). Following improvement in MR, Ea increased (1.54 ± 0.49 mmHg/mL vs. 1.84 ± 0.55 mmHg/mL, p = 0.004). Linear regression analysis revealed a correlation between Δtotal stroke volume (SV) and ΔEa (r = 0.614, p < 0.0001). Notably, ΔEa was higher in patients with ARD in LVEF than in those without ARD in LVEF (0.60 ± 0.73 mmHg/mL vs. 0.14 ± 0.39 mmHg/mL, p = 0.006).

Conclusion

ARD in LVEF after mitral TEER was reported in a substantial proportion of patients and may have prognostic implications. Evaluating cardio-mechanical parameters may aid in understanding complex hemodynamics and guiding treatment strategies for patients with MR undergoing TEER.