Background:
As mitral valve transcatheter edge-to-edge repair (TEER) has become an established therapy for functional regurgitation, recently more effort has been put in analyzing different subgroups and evaluating their periprocedural benefit. One of them representing atrial functional mitral regurgitation (aFMR), in which the pathomechanism is based on a (bi-)atrial and subsequent annular dilation, often described in context of atrial fibrillation or diastolic dysfunction. As this entity is still lacking a sharp definition, our aim was to evaluate certain characteristics of aFMR focused on diastolic dysfunction. 

 

Methods:

According to currently applying criteria for aFMR we retrospectively analyzed patients, that have been treated by mitral valve TEER at the university hospital Bonn between 09/11 and 12/21. Special interest was put in the echocardiographic parameters describing diastolic dysfunction, that were obtained before the procedure, at discharge and at the follow-up examinations.

 

Results:

We analyzed 123 patients (58,5% female; mean age: 79,9 ± 7,2) that were considered suffering from aFMR. Baseline revealed any type of atrial fibrillation in 88 % and a mean left ventricular ejection fraction of 59,7 ± 6,2 %. The results showed a significant periprocedural change in mitral regurgitation, with a reduction to ≤ grade 1+ in 76,4 % at discharge. Regarding echocardiographic surrogates for diastolic dysfunction, we found a significant periinterventional increase of the quotient E/e’ as well as the mitral valve deceleration time, while e’ was reduced. Further investigation revealed sex-dependent differences in preprocedural E/e’ (19,1 vs. 15,8; female vs. male; p = 0,03). Neither presence of atrial fibrillation nor diagnosed type of atrial fibrillation showed an effect on diastolic dysfunction.

 

Conclusion:

The results confirmed TEER as an effective treatment in aFMR as previously shown, reaching a significant periinterventional decline in mitral regurgitation grade. Evaluation of diastolic dysfunction revealed a periinterventional effect indicating an aggravation of diastolic dysfunction. Remarkably female patients presented with a significant higher grade of diastolic dysfunction.