{"id":"40a7fdbf9e4c","type":"article","url":"https://hartvaat.nl/2026/03/16/vroege-linkerventrikel-reverse-remodellering-na-mitralisklep-edge-to-edge-repara/","title":"Vroege linkerventrikel-reverse-remodellering na mitralisklep-edge-to-edge-reparatie (EXPAND)","title_en":"Left Ventricular Reverse Remodeling after Mitral Transcatheter Edge-to-Edge Repair: Results from the EXPANDed Studies","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitraclip"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag081","source_url":"https://doi.org/10.1093/eschf/xvag081","authors":["Mirjam Keßler","Gilbert H L Tang","Sébastien Deferm","Rodrigo Estevez-Loureiro","Wolfgang Rottbauer","Federico M Asch","Jose L Zamorano","Janani Aiyer","Rong Huang","Evelio Rodriguez","Saibal Kar","Francesco Maisano","Ralph Stephan von Bardeleben"],"significance":7,"published":"2026-03-16","source_date":"2026-03-16","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/ivabradine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/"],"congress":"","summary_en":"Left ventricular reverse remodeling (LVRR) is a key goal of heart-failure therapy. In the combined EXPAND and EXPAND G4 cohorts (2,205 patients after mitral transcatheter edge-to-edge repair, M-TEER), early (30-day) LVRR was examined, defined as a >10% reduction in LV dimension or volume. In secondary MR, 64% showed early LVRR; at one year these patients had fewer deaths or heart-failure hospitalisations (24.7% vs 35.9%), despite similar MR reduction and symptom improvement. In primary MR, LVRR occurred in 73% with broadly similar outcomes — except in dilated ventricles, where early LVRR was associated with lower mortality. Early LVRR after M-TEER, especially in secondary MR, is thus associated with better outcomes.","created":"2026-07-03T10:32:19Z","updated":"2026-07-03T13:31:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Linkerventrikel-reverse-remodellering (LVRR) is een belangrijk doel van hartfalentherapie. In de gecombineerde EXPAND- en EXPAND G4-cohorten (2.205 patiënten na mitralisklep-edge-to-edge-reparatie, M-TEER) werd vroege (30-daagse) LVRR onderzocht, gedefinieerd als een afname van de LV-dimensie of het LV-volume met meer dan 10%. Bij secundaire MR vertoonde 64% vroege LVRR; deze patiënten hadden na één jaar minder sterfte of hartfalenopname (24,7% versus 35,9%), ondanks vergelijkbare MR-reductie en symptoomverbetering. Bij primaire MR trad LVRR bij 73% op, met overall vergelijkbare uitkomsten — behalve bij gedilateerde ventrikels, waar vroege LVRR met lagere sterfte samenhing. Vroege LVRR na M-TEER, vooral bij secundaire MR, is dus geassocieerd met betere uitkomsten.","abstract_original":"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."}