Mitral transcatheter edge-to-edge repair (M-TEER) is increasingly used. Reverse remodeling is expected to impact prognosis, yet pre-operative prediction of the beneficial impact of MR treatment remains limited.

We aimed to describe the impact of M-TEER on heart remodeling according to etiology and to define pre-intervention parameters that might predict this beneficial heart remodeling after M-TEER.

Consecutive isolated M-TEER patients recruited between 2019 and 2022 were considered. Patients who died or required re-operation within 30 days were excluded (n=9). Preoperative echocardiograms were obtained in our center, as well as a follow up between 6 and 24 months, that were subjected to blinded quantitative analysis at the core lab. Patients without follow up at the TEER center were not included in the final analysis. Transthoracic echocardiography (TTE), including speckle-tracking imaging for left ventricular and atrial strains, was analyzed alongside clinical characteristics. Cardiovascular events and other occurrences were recorded up to a 24-month follow-up. The relative variation in left ventricular end-diastolic indexed volume compared to baseline and according to the etiology group was the primary outcome.

Eighty-six (out of 146) patients were included in the final analysis (55% men, 55% functional MR, median LVEF 56%, IQR [45–64]). Baseline characteristics did not significantly differ in the final analysis population compared to the whole cohort. The decrease in left ventricular end-diastolic volume indexed (LVEDVi) was greater in primary MR (–16.4% vs. –7.06%, P-value=0.04). Baseline global longitudinal strain (GLS) was the best independent parameter to predict changes in LVEDVi (P-value=0.03) (Fig. 1). In secondary MR, NYHA functional class improvement after TEER was also associated with relative change in GLS between baseline and follow-up. Reverse remodeling did not correlate with NT-proBNP evolution.

Mitral TEER has a greater impact on LVEDVi in primary MR. Baseline GLS is the parameter that should be considered to predict the amount of reverse remodeling expected after M-TEER.