An integrative approach to patient selection for mitral transcatheter edge-to-edge repair in secondary mitral regurgitation.

Brusosa M, Flores-Umanzor E, Horlick E.

ReviewAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

This review proposes an integrated, physiology-based framework for selecting secondary mitral regurgitation patients most likely to benefit from mitral transcatheter edge-to-edge repair, emphasizing that regurgitation severity should be judged relative to ventricular remodeling rather than using single echocardiographic thresholds alone.

What was studied

A narrative review synthesizing evidence from randomized trials and multimodality imaging approaches to propose a structured patient-selection framework for mitral transcatheter edge-to-edge repair in secondary mitral regurgitation.

Key findings

The divergent results of two major trials, MITRA-FR and COAPT, mainly reflected differences in echocardiographic patient selection and left ventricular remodeling, suggesting severity should be judged relative to ventricular size and regurgitant burden rather than in isolation.
Newer trials, RESHAPE-HF2 and MATTERHORN, broaden supportive evidence for the procedure in selected patients and as a safer alternative to surgery in some operable patients.
Regurgitant volume and regurgitant fraction, beyond effective regurgitant orifice area, better capture mitral regurgitation load; cardiac MRI can refine quantification when echocardiography is discordant or limited.
Right ventricular dysfunction and pulmonary vascular involvement are key modifiers of prognosis and expected benefit from the procedure.

Clinical relevance

This proposes that optimal candidate selection for transcatheter mitral repair in secondary mitral regurgitation requires a structured, multiparametric evaluation, confirming meaningful regurgitation despite optimal medical therapy, anatomic suitability, multiparametric severity quantification supplemented by cardiac MRI when needed, and assessment of right heart and pulmonary involvement, rather than relying on single echocardiographic thresholds.

Who should care

Cardiology

Limitations

This is a narrative review synthesizing existing trial and imaging evidence rather than new primary data; the proposed integrative framework has not itself been prospectively tested as a selection strategy.

Choosing the right secondary mitral regurgitation patients for transcatheter mitral valve repair requires looking beyond simple regurgitation severity thresholds to consider ventricular size, right heart function, and detailed imaging together, according to this proposed integrated selection framework.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Purpose of review

Secondary mitral regurgitation (SMR) remains a major contributor to symptoms and hospitalizations in heart failure, despite guideline-directed medical therapy (GDMT). This review synthesizes current evidence and proposes a structured framework for identifying patients most likely to benefit from mitral transcatheter edge-to-edge repair (M-TEER), integrating data from randomized clinical trials, proportionality concepts, and multimodality imaging.

Recent findings

Divergent results in MITRA-FR and COAPT mainly reflect differences in echocardiographic selection and left-ventricular remodeling, which means SMR severity should be judged relative to ventricular size and regurgitant burden. Contemporary trials such as RESHAPE-HF2 and MATTERHORN broaden the evidence and support M-TEER in selected patients and as a safer alternative to surgery in some operable cohorts. Beyond effective regurgitant orifice area, regurgitant volume and regurgitant fraction better capture MR load. Cardiac magnetic resonance refines quantification when echocardiography is discordant or limited. Right-ventricular dysfunction and pulmonary vascular involvement are key modifiers of prognosis and expected benefit.

Summary

Optimal candidate selection requires a structured, integrative evaluation: confirm clinically meaningful SMR despite GDMT, ensure anatomic suitability, quantify severity with a multiparametric echo approach supplemented by CMR when indicated, and incorporate ventricular-atrial-pulmonary coupling. This physiology-based strategy moves beyond single thresholds to identify patients most likely to achieve meaningful clinical benefit.

DOI

10.1097/hco.0000000000001330

PMID

42394523

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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