Atriogenic leaflet tethering, right ventricular dysfunction, residual mitral regurgitation, and elevated transmitral gradients are key predictors of non-response to TEER in atrial functional MR.
This review identifies specific anatomical, hemodynamic, and procedural factors that predict poor clinical response to TEER in atrial functional mitral regurgitation, which can help optimize patient selection and procedural planning.
Atrial functional mitral regurgitation (AFMR) is a distinct entity characterized by atrial remodelling and associated annular dilatation, rather than ventricular dysfunction and subsequent leaflet tethering/annular dilatation as seen in ventricular functional mitral regurgitation. Transcatheter edge-to-edge repair (TEER) provides symptomatic and hemodynamic improvement; however, clinical response remains heterogeneous. Recent studies have identified key anatomical, hemodynamic and procedural predictors of non-response, particularly atriogenic leaflet tethering, right ventricular dysfunction, residual post-procedural mitral regurgitation and elevated mean trans-mitral gradients. This review synthesizes the current evidence on predictors of TEER non-response in AFMR and their implications for optimizing patient selection and procedural planning.
Kandiah et al. (2026) studied this question. Atriogenic leaflet tethering, right ventricular dysfunction, residual mitral regurgitation, and elevated transmitral gradients are key predictors of non-response to TEER in atrial functional MR.