Sachiyo Ono; Shunsuke Kubo; Takeshi Maruo; Naoki Nishiura; Kazunori Mushiake; Kohei Osakada; Kazushige Kadota; Masanori Yamamoto; Mike Saji; Masahiko Asami; Yusuke Enta; Shinichi Shirai; Masaki Izumo; Shingo Mizuno; Yusuke Watanabe; Makoto Amaki; Kazuhisa Kodama; Junichi Yamaguchi; Yoshifumi Nakajima; Toru Naganuma; Hiroki Bota; Yohei Ohno; Masahiro Yamawaki; Hiroshi Ueno; Kazuki Mizutani; Toshiaki Otsuka; Kentaro Hayashida; OCEAN-Mitral investigators

doi:10.4244/EIJ-D-23-01092

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

The reference multimedia journal in interventional cardiology

Original Research

DOI: 10.4244/EIJ-D-23-01092

Predictors and clinical impact of worsening left ventricular ejection fraction after mitral transcatheter edge-to-edge repair

Sachiyo Ono¹, MD; Shunsuke Kubo¹, MD; Takeshi Maruo¹, MD; Naoki Nishiura¹, MD; Kazunori Mushiake¹, MD; Kohei Osakada¹, MD; Kazushige Kadota¹, MD; Masanori Yamamoto²^,³^,⁴, MD; Mike Saji⁵^,⁶, MD; Masahiko Asami⁷, MD; Yusuke Enta⁸, MD; Shinichi Shirai⁹, MD; Masaki Izumo¹⁰, MD; Shingo Mizuno¹¹, MD; Yusuke Watanabe¹², MD; Makoto Amaki¹³, MD; Kazuhisa Kodama¹⁴, MD; Junichi Yamaguchi¹⁵, MD; Yoshifumi Nakajima¹⁶, MD; Toru Naganuma¹⁷, MD; Hiroki Bota¹⁸, MD; Yohei Ohno¹⁹, MD; Masahiro Yamawaki²⁰, MD; Hiroshi Ueno²¹, MD; Kazuki Mizutani²², MD; Toshiaki Otsuka²³, MD; Kentaro Hayashida²⁴, MD; OCEAN-Mitral investigators

1. Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan; 2. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; 3. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; 4. Department of Cardiology, Gifu Heart Center, Gifu, Japan; 5. Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan; 6. Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan; 7. Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan; 8. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan; 9. Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan; 10. Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan; 11. Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan; 12. Department of Cardiology, Teikyo University School of Medicine, Itabashi, Japan; 13. Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan; 14. Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan; 15. Department of Cardiology, Tokyo Women’s Medical University, Shinjuku, Japan; 16. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan; 17. Department of Cardiology, New Tokyo Hospital, Chiba, Japan; 18. Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan; 19. Department of Cardiology, Tokai University School of Medicine, Isehara, Japan; 20. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan; 21. Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan; 22. Division of Cardiology, Department of Medicine, Kinki University Faculty of Medicine, Osaka, Japan; 23. Department of Hygiene and Public Health, Nippon Medical School, Bunkyo, Japan; 24. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

Abstract

BACKGROUND: Little is known about the effects of left ventricular ejection fraction (LVEF) worsening after transcatheter edge-to-edge valve repair (TEER) for mitral regurgitation (MR).

AIMS: This study investigated the predictors and clinical impact of LVEF worsening after TEER for primary MR (PMR) and secondary MR (SMR).

METHODS: This study included 2,019 patients (493 with PMR and 1,526 with SMR) undergoing successful TEER (postprocedural MR grade ≤2+) in the OCEAN-Mitral registry. The patients were categorised into worsened LVEF (wEF), defined as a relative decrease of >12.9% in LVEF at discharge, and preserved LVEF (pEF). The serial changes in left ventricular (LV) function at 1 year were also evaluated.

RESULTS: Following TEER, 657 (32%) patients demonstrated wEF. The pEF group demonstrated both decreased left ventricular end-diastolic volumes (LVEDV) and end-systolic volumes (LVESV), and the wEF group showed significantly increased LVESV at discharge. Higher LVEF, larger LVEDV, higher B-type natriuretic peptide levels, and moderate/severe aortic regurgitation predicted wEF. Compared with baseline, the wEF group still demonstrated lower LVEF (46% to 43%; p<0.001) but significantly increased stroke volume (48 mL to 53 mL; p=0.001) at 1 year. The incidence of death or heart failure hospitalisation was similar between the wEF and pEF groups (hazard ratio 1.14, 95% confidence interval: 0.72-1.80; p=0.84) and also in patients with PMR and SMR.

CONCLUSIONS: LVEF worsening after TEER was not uncommon and was caused by the increased LVESV. LV volumes and some patient-specific factors predicted worsened LVEF which was not associated with long-term clinical outcomes. OCEAN-Mitral registry: UMIN-CTR ID: UMIN000023653.

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