Background
Atrial functional mitral regurgitation (AFMR) with preserved left ventricular ejection fraction (LVEF) represents an increasingly recognized entity in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER). The present study aimed to evaluate clinical outcomes and identify predictors of adverse events in this specific population.
Methods
Of 12,716 patients with mitral regurgitation, 396 with normal LVEF underwent M-TEER between March 2017 and January 2024 at our center. Of these, 115 met the inclusion criteria (LVEF >50%, no wall motion abnormalities, diagnosis of AFMR). Baseline, echocardiographic, and procedural characteristics were analyzed retrospectively. Normally distributed variables were compared using the t-test, and non-normally distributed variables using the Mann–Whitney U-test (p < 0.05 significant).
Results
The mean age was 79.84 ± 6.34 years, 67.8% females. Median NT-proBNP was 2,228 pg/mL, and mean GFR was 48.58 ± 19.66 mL/min. Procedural success was achieved in 95.6% of cases. Within the first year after M-TEER, all-cause mortality was 14.8% (n = 17), while hospitalization for heart failure occurred in 15.7% (n = 18) of patients. Kaplan-Meier analyses and multivariate regression analyses were performed to identify risk factors and predictors for adverse outcome (i.e. mortality, heart failure hospitalization and NYHA > II).
Conclusion
M-TEER provided high procedural success and favorable one-year outcomes in patients with AFMR and preserved LVEF. Our findings highlight the safety and effectiveness of M-TEER in carefully selected AFMR patients, while emphasizing the need for larger studies to identify prognostic factors and confirm long-term benefits to guide decision-making in the future.
