# M-TEER werkt over het volledige LVEF-spectrum; vergroot linkeratrium-volume voorspelt slechtere uitkomst

*geplaatst 2026-06-06 · Hartfalen · ESC heart failure · doi 10.1093/eschf/xvag149 · https://hartvaat.nl/2026/05/22/m-teer-werkt-over-het-volledige-lvef-spectrum-vergroot-linkeratrium-volume-voors/*

Retrospectieve analyse van 93 opeenvolgende patiënten met symptomatische secundaire mitralisinsufficiëntie die tussen 2018 en 2022 mitral transcatheter edge-to-edge repair (M-TEER) ondergingen. Klinische verbetering (overleving zonder hartfalen-opname, NYHA I-II, KCCQ >60) na 36 maanden was vergelijkbaar bij gereduceerde en behouden LVEF (51,8% vs 62,5%; p=0,32). Sterfte was lager bij behouden LVEF (9,4% vs 29,6%). Een vergroot linkeratrium-volume (LAVI ≥60 mL/m²) was geassocieerd met hogere mortaliteit (29,4% vs 11,8%) en bleef significant na correctie. M-TEER biedt dus zinvolle winst over het hele LVEF-spectrum, waarbij linkeratrium-vergroting een marker is van gevorderde atriale ziekte en mogelijk pleit voor eerdere interventie.

## English: 

Retrospective analysis of 93 consecutive patients with symptomatic secondary mitral regurgitation who underwent mitral transcatheter edge-to-edge repair (M-TEER) between 2018 and 2022. Composite clinical improvement (survival without HF hospitalisation, NYHA I-II, KCCQ >60) at 36 months was similar in reduced and preserved LVEF (51.8% vs 62.5%; p=0.32). Mortality was lower with preserved LVEF (9.4% vs 29.6%). Enlarged left atrial volume index (LAVI ≥60 mL/m²) was associated with higher mortality (29.4% vs 11.8%) and remained significant after adjustment. M-TEER thus delivers meaningful benefit across the LVEF spectrum, with left atrial enlargement marking advanced atrial disease and potentially supporting earlier intervention.

## Abstract (original, from the publication)

BACKGROUND: Secondary mitral regurgitation (SMR) contributes substantially to morbidity and mortality in heart failure. Mitral transcatheter edge-to-edge repair (M-TEER) improves outcomes in patients with reduced left ventricular ejection fraction (LVEF), but evidence in patients with preserved LVEF-often reflecting atrial functional mitral regurgitation-remains limited. METHODS: We retrospectively analyzed 93 consecutive patients with symptomatic SMR treated with M-TEER between 2018 and 2022. Patients were stratified according to LVEF (<50% vs ≥50%) and left atrial volume index (LAVI <60 vs ≥60 mL/m2). The primary endpoint was comprehensive clinical improvement at 36 months, defined as survival without heart-failure hospitalization, New York Heart Association (NYHA) class I-II, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score >60. Kaplan-Meier and Cox proportional hazards analyses were performed. RESULTS: Among 87 patients with complete follow-up, 48 (55%) achieved the composite endpoint. Clinical improvement rates were similar in patients with reduced and preserved LVEF (51.8% vs 62.5%, p=0.32). All-cause mortality at 36 months was lower in preserved compared with reduced LVEF (9.4% vs 29.6%; log-rank p=0.03). Enlarged left atrial volume (LAVI ≥60 mL/m2) was associated with increased mortality (29.4% vs 11.8%; log-rank p=0.04). In Cox regression analyses adjusted for age and sex, LAVI remained associated with mortality risk. CONCLUSION: M-TEER provides sustained clinical benefit across the LVEF spectrum, including patients with preserved LVEF. Left atrial enlargement identifies patients with worse prognosis and may represent a marker of advanced atrial disease supporting earlier intervention.

Auteurs: Louise Rouleau, Marina Petersen Saadi, Adrien Al Wazzan, Prayuth Rasmeehirun, Guillaume L'official, Vincent Auffret, Guillaume Leurent, Emmanuel Oger, Erwan Donal

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Bron: ESC heart failure, https://doi.org/10.1093/eschf/xvag149. Bijgewerkt 2026-07-03T13:31:55Z. 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.