Myocardial deformation recovery after M-TEER: Associations with 1-year clinical improvement

Mitral transcatheter edge-to-edge repair (M-TEER) effectively reduces mitral regurgitation (MR), yet conventional metrics may incompletely capture myocardial recovery. Myocardial deformation imaging offers quantitative assessment of ventricular and atrial function and may provide mechanistic insight into clinical response.

To characterize longitudinal multichamber myocardial deformation recovery after M-TEER and examine its association with 1-year clinical improvement.

This single-center observational study included patients who underwent M-TEER with the MitraClip G4 system between January 2022 and January 2025. Echocardiography was performed at baseline, 30 days, and 1 year. Speckle-tracking analysis included left ventricular global longitudinal strain (LV GLS), right ventricular free-wall strain (RV-FWS), and left atrial reservoir strain (LARS). Clinical recovery was assessed using New York Heart Association (NYHA) class and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS). Mortality and heart failure hospitalization were recorded as descriptive 1-year outcomes. Associations between deformation recovery and clinical improvement were evaluated using correlation and multivariable regression models; exploratory event-stratified analyses were performed according to 1-year event status.

Among 118 consecutive patients undergoing M-TEER, 92 (78.0%) had analyzable speckle-tracking studies and comprised the primary analysis cohort. Procedural success was 95.7%, with durable MR ≤2+ in 98% at 1 year. LV, LA, and pulmonary pressure indices improved significantly over follow-up (all p < 0.001), whereas left ventricular ejection fraction (LVEF) remained unchanged. LV GLS, RV-FWS, and LARS improved significantly from baseline to 1 year (all p < 0.001). Improvements in LV GLS, RV-FWS, and LARS correlated with NYHA improvement and KCCQ-OS gain (all p ≤ 0.001). In multivariable models, LARS (β = 1.9 points per 1% increase, p < 0.001) and LV GLS (β = 2.6 points per 1% improvement, p = 0.002) remained independently associated with greater health-status improvement and materially improved the explanatory performance of the clinical model.

Myocardial deformation analysis after M-TEER identifies multichamber functional recovery and is associated with 1-year symptom and health-status improvement. These findings support deformation imaging as a clinically relevant tool for characterizing recovery after M-TEER.