Estimating Left Atrial Pressure Using Diastolic Cutoff Values After Transcatheter Mitral Valve Edge-to-Edge Repair

Background: Transcatheter mitral valve edge-to-edge repair (M-TEER) reduces mitral regurgitation (MR) severity and improves symptoms, but early post-procedural assessment of left atrial pressure (LAP) remains challenging. Objectives: Investigating the impact of M-TEER on diastolic parameters and derived cutoff values to estimate post-procedural LAP. Methods: This retrospective study (n = 240) analyzed the effects of M-TEER on diastolic parameters. Cutoff values for predicting normal LAP were identified using classification tree analysis and validated with current methods for assessing LAP. Results: M-TEER increased E/e′ ratio in both normal and abnormal left ventricular ejection fraction (LVEF) groups. In normal LVEF, E wave velocity ≤ 85 cm/s at 30 days correlated with normal LAP (98% specificity, 90% positive predictive value). In abnormal LVEF, E/e′ ≤ 14 or E wave velocity ≤ 95 cm/s correlated with normal LAP (98%/90% specificity, 91%/83% positive predictive value). The validation of the proposed cutoff values with existing non-invasive methods showed 96% accuracy for normal LAP (24/25) and 90% for elevated LAP (27/30). Conclusions: M-TEER significantly alters diastolic parameters. Derived cutoff values based on easily obtainable diastolic measures show promise in estimating post-procedural LAP, but need further validation for clinical use.