Prognostic value of echocardiographic velocity time integral ratio post transcatheter edge-to-edge mitral valve repair

Objective Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTI MV/LVOT ), a simple Doppler measurement that increases with MR, has not been assessed post TEER. Methods Baseline characteristics, clinical outcomes, and TTE data from patients who underwent TEER between 2014 and 2021 across three academic centers were analyzed. Post-procedure TTEs were evaluated for VTI MV/LVOT in the first three months after TEER. One-year outcomes including all-cause and cardiac mortality, major adverse cardiac events, and MV reintervention were compared between patients with high VTI MV/LVOT (≥ 2.5) and low (< 2.5). Results In total, 372 patients were included (mean age 78.7 ± 8.8 years, 68% male, mean pre-TEER ejection fraction of 50.5 ± 14.7%). Follow up TTEs were performed at a median of 37.5 (IQR 30 - 48) days post-procedure. Patients with high VTI MV/LVOT had significantly higher all-cause mortality (HR 2.10, p = 0.003), cardiac mortality (HR 3.03, p = 0.004) and heart failure admissions (HR 2.28, p < 0.001) at one-year post-procedure. There was no association between raised VTI MV/LVOT and subsequent MV reintervention. Conclusion High VTI MV/LVOT has clinically significant prognostic value at one year post TEER. This tool could be used to select patients for consideration of repeat intervention. What is already known on this topic Residual mitral valve dysfunction after transcatheter edge-to-edge repair (TEER) is common and associated with poorer clinical outcomes. Quantification and subsequent prognostication are complex and challenging. What this study adds The ratio of velocity time integral of the mitral valve to left ventricular outflow tract on echocardiography (VTI MV/LVOT ) independently predicts risk of all-cause and cardiac mortality and heart failure admissions at one year following TEER. How this study might affect research, practice or policy These findings may allow for early identification of a high-risk cohort post TEER that may benefit from closer surveillance and more aggressive intervention.