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Using Transmitral Pressure Gradients and Residual Mitral Regurgitation to Optimize Outcome After Transcatheter
Hiroshi Tsunamoto1, Masanori Yamamoto2, Ai Kagase3
1Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Journal of the American College of Cardiology
|November 5, 2025
Summary
Elevated transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER) for functional mitral regurgitation (FMR) increases risks. Achieving both mild residual MR and low TMPG is crucial for better outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Reducing mitral regurgitation (MR) after mitral transcatheter edge-to-edge repair (M-TEER) is vital for patient outcomes.
- The impact of elevated transmitral mean pressure gradient (TMPG) post-M-TEER remains a subject of ongoing research and debate.
Purpose of the Study:
- To investigate the clinical significance of MR reduction and TMPG elevation in patients with functional mitral regurgitation (FMR) undergoing M-TEER.
- To assess the prognostic value of postprocedural hemodynamic parameters in FMR patients treated with M-TEER.
Main Methods:
- A cohort of 2,360 FMR patients treated with M-TEER was analyzed using postdischarge echocardiography.
- Patients were stratified into five groups based on residual MR severity and TMPG levels to evaluate outcomes.
- The primary endpoint was defined as all-cause death or heart failure hospitalization, assessed via spline and group comparisons.
Main Results:
- Higher TMPG levels correlated with increased 2-year event rates for the primary endpoint (25.0% at 1 mm Hg to 47.0% at 6 mm Hg).
- Increased TMPG was an independent predictor of adverse outcomes (HR: 1.10 per 1 mm Hg increment; P = 0.008).
- Patients achieving mild or moderate MR with low TMPG (<5 mm Hg) exhibited the most favorable prognosis.
Conclusions:
- Elevated TMPG post-M-TEER is consistently linked to a higher risk of adverse events in FMR patients.
- Achieving both significant MR reduction and maintaining a low TMPG is essential for optimizing patient prognosis after M-TEER.
- Balancing MR reduction and TMPG management may enhance risk stratification strategies in patients undergoing M-TEER.
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