Prognostic Impact of Supranormal LVEF Following Mitral Valve TEER in Patients With Secondary Atrial MR

BACKGROUND: The concept of supranormal left ventricular ejection fraction (snLVEF) has recently gained prominence. Among patients with heart failure and preserved ejection fraction, those exhibiting snLVEF have demonstrated worse clinical outcomes compared to individuals with normal left ventricular ejection fraction (LVEF). However, the prognostic implications of snLVEF in the context of transcatheter edge-to-edge repair (TEER) for secondary atrial mitral regurgitation remain insufficiently elucidated. OBJECTIVES: The purpose of this study was to investigate the prognostic impact of snLVEF in patients receiving TEER for secondary atrial mitral regurgitation. METHODS: This study evaluated patients with an LVEF ≥50% who underwent TEER using the MitraClip system for secondary atrial mitral regurgitation, as documented in the multicenter, investigator-initiated OCEAN-Mitral registry. snLVEF was defined as an LVEF ≥65%. The association between baseline snLVEF and 2-year mortality following TEER was analyzed. RESULTS: The study included 529 patients (median age 83 years, 213 men). Of these, 137 patients were identified with snLVEF, while the remainder exhibited normal LVEF. Patients with snLVEF were characterized by smaller left ventricular dimensions and more severe tricuspid regurgitation relative to those with normal LVEF. The presence of snLVEF was independently associated with a significantly elevated risk of 2-year mortality following TEER, with an adjusted HR of 1.86 (95% CI: 1.21-2.86; P = 0.005). CONCLUSIONS: snLVEF emerged as an independent predictor of increased mortality following TEER for secondary atrial mitral regurgitation vs normal LVEF. (OCEAN-Mitral registry; UMIN000023653).