The identification value of common echocardiography parameters for improvement of mitral regurgitation after transcatheter aortic valve replacement in patients with aortic stenosis

Objective: To analyze the factors influencing mitral regurgitation (MR) improvement in patients with aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR), and to evaluate the identification value of echocardiographic parameters. Methods: One hundred seventy-eight patients underwent TAVR at the First Affiliated Hospital of Xi'an Jiaotong University were finally enrolled. The severity of MR was graded into four levels based on baseline echocardiographic MR area. MR improvement group was defined as a reduction of at least one grade at 6-month follow-up in patients with grade ≥ 2 at baseline, among whom improvement before discharge was defined as early improvement, with the remainder classified as delayed improvement. Comparative analysis, logistic regression and firth regression were used to analyze factors associated with MR improvement. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of echocardiographic parameters to identify MR improvement. Results: Fifty-five patients (30.9%) had MR grade ≥ 2 at baseline, and 46 completed the 6-month follow-up. Comparative analysis revealed that the non-improvement group had lower N-terminal pro-brain natriuretic peptide (NT-proBNP), smaller left ventricular dimensions, and a trend toward larger left atrial diameter. Left atrial-to-ventricular ratio (LAVR) was significantly larger in non-improvement group. Compared with the delayed improvement group, patients with early improvement were younger and had larger left ventricular and atrial diameter. Logistic regression showed that LAVR was independently associated with whether MR improved after TAVR. ROC analysis indicated that LAVR may identify MR improvement after TAVR. Conclusion: Moderate-to-severe MR could improve after TAVR in majority of patients with severe AS. LAVR, which integrates atrial and ventricular echocardiographic diameters, can provide clues for risk stratification regarding whether MR improves after TAVR.