P267 ASSOCIATION BETWEEN EARLY MODIFICATION OF LEFT ATRIAL VOLUME AND RIGHT VENTRICULAR FUNCTION AFTER TRANSCATHETER EDGE–TO–EDGE REPAIR FOR MITRAL REGURGITATION

Abstract

Abstract Background Transcatheter edge–to–edge repair (TEER) for severe mitral regurgitation (MR) is a therapeutic option in patients at high surgical risk. Post procedural reverse remodeling of the left ventricle, the left atrium (LA) and the right ventricle (RV) was shown to be associated with reduced symptoms and mortality. Methods In this retrospective study we have assessed consecutive patients with functional severe MR from February 2015 to July 2022. LA and RV structure and function have been evaluated before the procedure and at the discharge and they were correlated with symptoms. Results In the present study, 52 patients (69% males, mean age 65.2±10.2 years and mean left ventricular ejection fraction 28.8±5.7%) were included. No differences about baseline clinical and echocardiographic characteristics were reported in the group of patients who had LA volume reduction (n=31) and those who did not (n=21). In the overall population we have detected a significant increase of tricuspid annular plane systolic excursion (TAPSE), S‘ wave at Tissue Doppler and the ratio between TAPSE and systolic pulmonary artery pressure (SPAP), together with a significant reduction of SPAP (respectively, p=0.034, p=0.003, p<0.001 and p<0.001). Compared to patients who did not have LA volume reduction, the other group showed a significant increase of TAPSE/SPAP (from 0.40±0.17 to 0.52±0.21 mm/mmHg, p=0.002) and S’ wave (from 8.7±1.6 to 9.4±1.7 cm/s, p=0.005) and a reduction of SPAP (from 50.3±14.3 to 38.9±11.5 mmHg, p<0.001). LA volume modification from baseline to the discharge was associated with the modifications of SPAP (B coefficient 0.55, 95% confidence interval 0.09, 1.02, p=0.022) and TAPSE/SPAP (B coefficient –4.06, 95% confidence interval –7.78, –0.33, p=0.033), even at the multivariable analysis (respectively, B coefficient 0.61, 95% confidence interval 0.07, 1.14, p = 0.027 e B coefficient –4.82, 95% confidence interval –9.43, –0.23, p=0.040). Lastly, NYHA class improved in the group of patients who had LA volume reduction (p=0.011). Conclusion In this retrospective study an association between early modification of LA volume and RV functional parameters has been described. After TEER, RV function improved, particularly in the group of patients who had LA volume reduction. The latter have shown an improvement of symptoms at the discharge.