{"id":"668b6daaf45c","type":"article","url":"https://hartvaat.nl/2026/03/23/residuele-linker-atriale-v-golf-voorspelt-de-uitkomst-van-mitralisklep-edge-to-e/","title":"Residuele linker-atriale v-golf voorspelt de uitkomst van mitralisklep-edge-to-edge-reparatie","title_en":"Residual left atrial v wave predicts clinical outcome of transcatheter edge-to-edge mitral valve repair","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["mitraclip"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag086","source_url":"https://doi.org/10.1093/eschf/xvag086","authors":["Michael Paulus","Jonas Rösch","Franziska Grewe","Moritz Haus","Valeska Bienert","Michael Wester","Christian Schach","Andreas Luchner","Christoph Birner","Bernhard Unsöld","Lars S Maier","Kurt Debl","Christine Meindl"],"significance":7,"published":"2026-03-23","source_date":"2026-03-23","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"Intraprocedural assessment of residual mitral regurgitation (MR) is crucial in transcatheter edge-to-edge mitral repair (M-TEER) but difficult with ambiguous echo findings. In this prospective study (299 patients, 63% secondary MR), left-atrial mean pressure and v-wave pressure (LAvP) were measured before and after implantation. LAvP fell from 30.5 to 23.2 mmHg. High residual LAvP after implantation strongly predicted death or heart-failure hospitalisation over two years, independent of echocardiographic MR grade (HR per 10 mmHg ~1.3). Residual LAvP below 25 mmHg was associated with favourable outcome, even with residual MR grade I–II. LAvP measurement thus adds prognostic information and may support intraprocedural decision-making.","created":"2026-07-03T10:32:18Z","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":"Intraprocedurele beoordeling van residuele mitralisinsufficiëntie (MR) is cruciaal bij transkatheter edge-to-edge-mitralisreparatie (M-TEER), maar bij dubbelzinnige echobevindingen lastig. In deze prospectieve studie (299 patiënten, 63% secundaire MR) werden de linker-atriale gemiddelde druk en de v-golfdruk (LAvP) vóór en na implantatie gemeten. De LAvP daalde van 30,5 naar 23,2 mmHg. Een hoge residuele LAvP na implantatie voorspelde sterk overlijden of hartfalenopname over twee jaar, onafhankelijk van de echografische MR-graad (HR per 10 mmHg circa 1,3). Een residuele LAvP onder 25 mmHg ging gepaard met een gunstige uitkomst, ook bij restant-MR graad I–II. LAvP-meting biedt dus aanvullende prognostische informatie en kan de intraprocedurele besluitvorming ondersteunen.","abstract_original":"AIMS: Intraprocedural assessment of residual mitral regurgitation (MR) is crucial for success of transcatheter edge-to-edge mitral valve repair (M-TEER) yet challenging in the case of ambiguous echocardiographic findings. Monitoring left atrial (LA) pressure can complement evaluation of residual MR after device placement. This study aimed to determine the prognostic impact of intraprocedural changes in LA pressure on the clinical outcome following M-TEER. METHODS: We enrolled 299 patients undergoing M-TEER for primary or secondary MR in a prospective observational study. During the procedure, LA mean (LAmP) and LA v wave pressure (LAvP) were recorded before and after device implantation. The primary endpoint was death or hospitalization for heart failure during a 2-year follow-up. RESULTS: Mean age of the study population was 76.6±8.2 years. Secondary mitral regurgitation was identified in 62.9% of the patients. Reduction to MR grade I or II was achieved in 95.3% of cases. During M-TEER, LAvP decreased from 30.5±15.0 to 23.2±10.4 mmHg (p<0.001) after device implantation, accompanied by a modest reduction of LAmP from 16.6±6.3 to 15.3±5.9 mmHg (p=0.006). LAvP post M-TEER was a strong predictor of death or hospitalization for heart failure in both univariate and multivariate analysis, independent of echocardiographic MR severity (hazard ratio per 10 mmHg 1.37 [1.15-1.63], p<0.001 and 1.29 [1.06-1.57], p=0.012). Residual LAvP below 25 mmHg was strongly associated with favourable outcome irrespective of residual echocardiographic MR grade, including patients with residual MR grade I and II. CONCLUSION: High residual LAvP predicts death or hospitalization for heart failure after M-TEER. LAvP after device implantation provides incremental prognostic information beyond echocardiographic MR grading and may therefore assist intraprocedural decision-making during M-TEER."}