Left and Right Ventricular Hemodynamic Response After Transcatheter Mitral Valve Replacement

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Biomedical Engineering

Background:

• Transcatheter mitral valve replacement (TMVR) is a novel therapy for mitral regurgitation (MR).
• Hemodynamic effects of MR elimination post-TMVR on ventricular function are not well understood.
• Noninvasive pressure-volume loops offer a method to assess these changes.

Purpose of the Study:

• To investigate the hemodynamic impact of TMVR on left ventricular (LV) and right ventricular (RV) function.
• To assess changes in LV and RV performance using noninvasive pressure-volume loops.
• To evaluate the prognostic significance of hemodynamic changes after TMVR.

Main Methods:

• Prospective enrollment of 26 patients undergoing TMVR between May 2016 and August 2022.
• Estimation of LV pressure-volume relationships using single-beat echocardiography at baseline and post-TMVR.
• Assessment of RV function via RV-pulmonary artery (PA) coupling and RV fractional area change.

Main Results:

• Successful TMVR in 26 patients (77% male, 81% secondary MR) with baseline LV ejection fraction of 37%.
• Post-TMVR showed reduced LV filling pressures (VPed20) and increased LV contractility (end-systolic elastance).
• RV function (RV-PA coupling, RV fractional area change) remained unchanged; VPed20 reduction predicted better 1-year survival.

Conclusions:

• Noninvasive pressure-volume loops reveal early LV reverse remodeling and improved contractility post-TMVR.
• RV performance is preserved after TMVR.
• Reduced LV filling pressure after TMVR has prognostic implications for mortality and heart failure hospitalization.