Echocardiographic Indices of Cardiac Remodeling Following Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Analysis

BACKGROUND: Secondary mitral regurgitation is associated with adverse clinical outcomes and cardiac remodeling. While transcatheter edge-to-edge repair (TEER) improves symptoms and prognosis in selected patients, its effects on cardiac remodeling remain debated. This systematic review and meta-analysis aimed to evaluate the impact of TEER on echocardiographic indices of cardiac remodeling. METHODS: PubMed, Scopus, and Cochrane Library were used to identify relevant studies assessing echocardiographic changes before and after TEER. Outcomes of interest were left ventricular (LV) ejection fraction, global longitudinal strain, LV end-diastolic and end-systolic volumes and LV end-diastolic and end-systolic diameter, tricuspid annular plane systolic excursion, pulmonary artery systolic pressure, and left atrial end-systolic volume. RESULTS: Forty-two studies (3987 patients) were included. TEER was associated with a significant increase in LV ejection fraction (mean difference [MD], 1.51% [95% CI, 0.47–2.55]), without significant improvement in global longitudinal strain. Significant LV remodeling was observed, with reductions in LV end-diastolic volume (standardized MD, −0.26 [95% CI, −0.37 to −0.14]), LV end-systolic volume (standardized MD, −0.21 [95% CI, −0.30 to −0.12]), LV end-diastolic diameter (MD, −2.35mm [95% CI, −3.66 to −1.04]) and left ventricular end-systolic diameter (MD, −2.30mm [95% CI, −3.86 to −0.74). TEER also improved right ventricular function (tricuspid annular plane systolic excursion [MD, 1.29mm [95% CI, 0.60–1.97]) and reduced pulmonary artery systolic pressure (MD, −6.75mmHg [95% CI, −8.53 to −4.97). No significant improvement in left atrial end-systolic volume was detected. CONCLUSIONS: Available evidence suggests that TEER promotes significant cardiac remodeling in patients with secondary mitral regurgitation.