A Novel Invasive Hemodynamic Parameter (V′) to Predict Hemodynamic Response to Mitral Transcatheter Edge-to-Edge Repair

Abstract

Background

Left atrial (LA) V-wave amplitude can be higher with elevated left ventricular end-diastolic pressure, mitral regurgitation (MR), or both. This may cause hemodynamic and echocardiographic discordance when assessing MR. Identifying more specific hemodynamic correlates to MR severity helps in the setting of discordance. We examined the amplitude of the V-wave relative to the LA mean pressure following the reduction in MR after mitral transcatheter edge-to-edge repair (M-TEER).

Methods

A total of 231 patients who underwent M-TEER between 2019 and 2022 with reliable intraprocedural invasive hemodynamic waveforms were included. LA mean and V-wave pressures were measured pre- and post-M-TEER. V′ was calculated as follows: (V′ = V-wave – mean pressure).

Results

Our cohort (median age 79) included 65% and 35% patients with primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR), respectively. LA mean, V-wave, and V′ pressures decreased significantly after M-TEER in both groups. SMR patients had higher LA pressures after M-TEER. Baseline and post–M-TEER V′ did not differ among groups. In the overall cohort, pre– and post–M-TEER V′ were significantly higher in patients with >2+ residual MR compared to ≤2+ MR. Patients with post–M-TEER V′ >13 mmHg had worse composite outcomes of heart failure hospitalization or all-cause mortality (hazard ratio: 3.01; 95% CI: 1.68-5.4; p < 0.001).

Conclusion

M-TEER decreased LA mean, V-wave, and V′ pressures in PMR and SMR. Postprocedural V′ provides a useful measure of residual MR and clinical outcomes and guides the adequacy of M-TEER.