Iatrogenic ASD gradient as a marker of residual mitral regurgitation severity after M-TEER procedure
A Kalompatsou, I Kachrimanidis, Y Dimitroglou, D Tsartsalis, C L Ververeli, S Tsalamandris, K Aznaouridis, K Dimitriadis, M Drakopoulou, K Tsioufis, K Toutouzas, C AggeliAbstract
Introduction
Assessment of procedural success following transcatheter mitral edge-to-edge repair (M-TEER), including non-invasive parameters, remains challenging.
Purpose
The association between iatrogenic atrial septal defect (iASD) gradient and post-procedural three-dimensional vena contracta area (3D-VCA) as a marker of residual mitral regurgitation severity has not been clearly defined.
Methods
In this prospective study, 26 patients who underwent M-TEER at a tertiary cardiovascular center were analyzed over the past year. Median age was 78 years (IQR 74–81.2), and 80.7% were male. Secondary mitral regurgitation was present in 50%, primary in 34.6%, and mixed etiology in 15.3%. The median post-procedural transmitral valve gradient was 2 mmHg (IQR 2–3), assessed by transesophageal echocardiography. Continuous-wave Doppler recordings across the iASD were obtained intraoperatively immediately after catheter withdrawal from the left atrium. The largest systolic 3D-VCA was quantified by direct planimetry from en face short-axis views using multiplanar reconstruction. Patients were stratified according to post-procedural 3D-VCA (≤0.2 vs >0.2, cm2). Diagnostic accuracy of the iASD gradient for identifying 3D-VCA >0.2cm2 was assessed using receiver operating characteristic (ROC) curve analysis, with optimal cutoff determined by the Youden index.
Results
Patients with post-procedural 3D-VCA >0.2 cm² demonstrated significantly higher iASD gradients than those with 3D-VCA ≤0.2 cm² (5.64±2.84 vs 3.07±1.10 mmHg, p=0.007). ROC analysis demonstrated good discriminatory ability for identifying 3D-VCA >0.2cm2 (AUC 0.81, 95% CI 0.61–0.97). An optimal iASD cutoff gradient ≥5 mmHg yielded a sensitivity of 63.6% and specificity of 93.3% for predicting 3D-VCA >0.2 cm².
Conclusion
The iASD gradient is associated with residual mitral regurgitation severity and shows good diagnostic accuracy for detecting 3D-VCA >0.2 cm². An iASD gradient ≥5 mmHg may serve as a simple and highly specific marker for immediate post-procedural assessment after M-TEER; however, validation in larger cohorts is required.Violin PlotFor image description, please refer to the figure legend and surrounding text.ROC curveFor image description, please refer to the figure legend and surrounding text.