Transcatheter mitral valve edge-to-edge repair for severe mitral regurgitation in patients with HFpEF phenotype

Background The increasing prevalence of heart failure with preserved ejection fraction (HFpEF) is often accompanied by mitral regurgitation (MR). Transcatheter edge-to-edge repair (M-TEER) is established for treating MR in heart failure with reduced ejection fraction (HFrEF), but its impact in patients with HFpEF phenotype is unclear. Aim To investigate the effect of M-TEER in patients with HFpEF phenotype and concomitant MR based on diagnostic criteria according to current ESC guidelines and established HFpEF scores. Methods 181 patients with severe MR underwent M-TEER at our center with HFpEF phenotype. Echocardiography, symptom burden (NYHA class), quality of life (MLWHFQ, SF-PCS, and functional capacity (6MWD) were assessed before and 30 days after M-TEER. Survival and rehospitalisation rates were assessed at long-term follow-up. Results M-TEER in patients with HFpEF phenotype significantly reduced MR grade and improved symptom burden, quality of life, and exercise capacity. Patients with either primary or secondary MR experienced clinically relevant symptomatic improvement for MLWHFQ (69%) and SF-PCS (60%) as well clinically relevant increase (44%) of the 6MWD. The clinical outcome between patients with primary or secondary MR was comparable. Severe tricuspid regurgitation (TR) complicating HFpEF was independently linked to an increased mortality risk (HR 3.66, 95%CI 1.32–10.15, p = 0.013). Conclusion M-TEER is an effective treatment for both severe primary and secondary MR in patients with HFpEF phenotype, significantly reducing MR and improving symptoms. The independent association of severe TR with increased all-cause mortality highlights the importance of timely intervention to prevent right heart failure and worse outcomes.