Vroege linkerventrikel-reverse-remodellering na mitralisklep-edge-to-edge-reparatie (EXPAND)

BACKGROUND: Left ventricular reverse remodeling (LVRR) is a key objective of contemporary heart failure (HF) therapies and is characterized by reversal of left ventricular (LV) dilation and dysfunction. OBJECTIVES: To report the incidence and clinical impact of early (30-day) LVRR patients with primary (PMR) and secondary mitral regurgitation (SMR) treated with mitral transcatheter edge-to-edge repair (M-TEER), and to identify independent associations with early LVRR. METHODS: The EXPANDed cohort includes 2205 patients treated with M-TEER from the EXPAND and EXPAND G4 studies. Patients were classified as having early LVRR if they demonstrated a >10% reduction in LV dimension or volume from baseline to 30 days. All LV measurements were assessed by independent echocardiographic core laboratories. RESULTS: Among 527 SMR patients, 338 patients (64.1%) experienced early LVRR after M-TEER. At 1 year, SMR patients with early LVRR had significantly lower rates of death or HF hospitalizations compared to those without (early LVRR: 24.7% vs no early LVRR: 35.9%, p=0.009), despite similar MR reduction (both ≥93% in both groups) and comparable improvements in functional status (NYHA≤II ≥78%) and quality of life (∼20-points improvement per KCCQ-OS). Independent associations with early LVRR included hypertension (OR=1.96, p=0.004), absence of prior cardiac surgeries (OR=0.51, p=0.002), and smaller LV end-systolic volume (OR=0.81, p=0.002).Among 536 PMR patients, 391 (73.0%) experienced early LVRR at 30 days. At 1 year, PMR patients with early LVRR group had similar clinical (composite all-cause mortality or HF hospitalization: early LVRR: 14.5% vs no early LVRR: 17.1%, p=0.47) and symptomatic outcomes (≥83% NYHA≤II; ∼19-point improvement per KCCQ-OS) compared to those without. However, among PMR patients with dilated ventricles, early LVRR group was associated with significantly lower all-cause mortality (early LVRR: 3.8%, no Early LVRR: 14.0%, p=0.028). CONCLUSIONS: Regardless of etiology, most patients experienced early LVRR after M-TEER with significant MR reduction and symptom relief. In SMR patients, early LVRR was associated with lower rates of HF hospitalization and death.