Key result
Mitral regurgitation proportionality shows no link to mortality or heart failure hospitalization after TEER.
Why the study?
Clinical markers identifying which patients with functional MR benefit from TEER are not established, though MR proportionality relative to LV size has been hypothesized to predict outcomes.
Does mitral regurgitation proportionality predict all-cause mortality or heart failure hospitalization in patients undergoing TEER for functional mitral regurgitation?
Meta-Analysis (n=1,594)
Does mitral regurgitation proportionality predict all-cause mortality or heart failure hospitalization in patients undergoing TEER for functional mitral regurgitation?
Effect estimate: RR 0.80 (95% CI 0.45-1.44)
In patients undergoing TEER for functional mitral regurgitation, MR proportionality does not significantly predict all-cause mortality, heart failure hospitalization, or residual MR.
MR proportionality lacks prognostic value after TEER; challenges its role in patient selection and leaves open refined risk stratification.
Background: Certain patients with functional mitral regurgitation survive longer with fewer heart failure hospitalizations after undergoing transcatheter edge-to-edge repair (TEER); however, clinical markers identifying who will benefit have not been established. The 'proportionality' of mitral regurgitation (MR) severity compared to left ventricular size has been hypothesized to predict clinical outcome. Methods: We sought to combine existing studies to compare outcomes between 'proportionate' MR and 'disproportionate' MR in patients undergoing TEER. PubMed and Medline were searched from January 2018 until May 2023. Data was extracted and synthesized by 2 independent authors using random effects models with risk ratios (RRs) for binary outcomes. The primary outcome was a combined endpoint of all-cause mortality or heart failure hospitalization (ACM/HFH). Other outcomes of interest included ACM and residual >2+ MR after TEER. Results: Six trials with a total of 1594 patients (mean age 71 years, 66% male) were included, which assessed MR proportionality using either a ratio of estimated regurgitant orifice area to left ventricular end-diastolic volume (EROA:LVEDV) or regurgitant fraction. Seven hundred and five (mean age 70 years, 75% male) were classified as proportionate MR, and 889 (mean age 72 years, 60% male) had disproportionate MR. There was no significant association between MR proportionality (by EROA:LVEDV) and ACM (RR 0.79, 95% confidence interval [CI] 0.44-1.42). Proportionality did not significantly associate with ACM/HFH, though there were divergent effect signals when proportionality was measured by EROA:LVEDV (RR 0.80, 95% CI 0.45-1.44) or regurgitant fraction (RR 1.48, 95% CI 0.53-4.11). Disproportionate MR showed a greater association with residual MR > 2+ post-TEER that did not meet statistical significance (RR 1.86, 95% CI 0.77-4.49). Conclusions: In patients undergoing TEER for functional mitral regurgitation, MR proportionality was not significantly associated with ACM/HFH, all-cause mortality, or residual MR.
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Moonen et al. (2024) conducted a meta-analysis in Functional mitral regurgitation (n=1,594). Proportionate mitral regurgitation vs. Disproportionate mitral regurgitation was evaluated on Combined endpoint of all-cause mortality or heart failure hospitalization (ACM/HFH) (RR 0.80, 95% CI 0.45-1.44). Mitral regurgitation proportionality was not significantly associated with all-cause mortality or heart failure hospitalization after TEER (RR 0.80; 95% CI 0.45-1.44 for EROA:LVEDV).
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