Abstract 4362777: Predictors of Left Atrial Compliance and V-Wave Response in Transcatheter Mitral Valve Therapy

Background: Severe mitral regurgitation (MR) is typically associated with large V-waves on invasive hemodynamic monitoring. However, discrepancies often arise between echocardiographic assessments of MR severity using color Doppler and invasive hemodynamic measurements. These inconsistencies are largely influenced by left atrial (LA) compliance, which affects the magnitude of V-waves. We sought to identify non-invasive predictors of invasive LA compliance and V-wave response in patients undergoing transcatheter mitral valve therapies (TMVT). Hypothesis: Which echocardiographic and clinical factors are predictive of invasive LA compliance in patients undergoing TMVT for severe MR? Methods: Patients with severe MR who achieved MR resolution (≤1+ post-procedure) following TMVT by either transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) were included in the study. The compliant LA group consisted of patients with severe MR by color Doppler who had either a baseline LA mean pressure ≤12 mmHg or a concordant hemodynamic response, defined as ≥50% reduction in V-wave magnitude along with MR resolution. The non-compliant LA group included patients with a baseline LA mean pressure >12 mmHg and a discordant response, defined as <50% V-wave reduction despite MR resolution. Multivariable logistic regression was performed to identify independent predictors of LA compliance. Results: A total of 248 patients were included in the analysis, of whom 41 underwent TMVR and 207 underwent TEER. The mean age was 77.3 years, and 63% were male. Overall, 103 patients (41.5%) were classified as having a compliant LA, while 145 (58.5%) were classified as non-compliant. On multivariable logistic regression, two independent predictors of a non-compliant LA were identified: lower LA reservoir strain (OR 1.11; 95% CI, 1.04–1.19; p=0.002) and a history of prior atrial intervention; either atrial fibrillation intervention or left atrial appendage ligation (OR 0.28; 95% CI, 0.09-0.83; p=0.02) (Figure 1). Conclusion: Reduced LA reservoir strain and a history of atrial intervention are significantly associated with lower LA compliance and a blunted V-wave response following TMVT. These non-invasive markers may help identify patients with impaired LA mechanics and inform procedural planning and expectations.