Impact of Change in the Left Ventricular Ejection Fraction and its Prognostic Value in Patients with Heart Failure after MitraClip

Objective Periprocedural changes in left ventricular ejection fraction (LVEF) and their clinical implications in patients undergoing MitraClip have not yet been fully investigated. This study aimed to evaluate the periprocedural and longitudinal changes in LVEF and their prognostic value in patients with mitral regurgitation (MR) treated with MitraClip. Methods We evaluated consecutive patients who underwent MitraClip implantation between January 2019 and December 2022. The changes in LVEF were assessed immediately after the procedure and during the follow-up period. The patients were categorized into three groups: worsening LVEF (≥5% decrease), stable LVEF (change of -4 to +4%), and improving LVEF (≥5% increase). The primary endpoint was a composite of cardiovascular death and hospitalization for heart failure (HF). Results Overall, 98 patients were enrolled, of whom 72 had secondary MR. During a median follow-up period of 433 days, 29 (30%) primary endpoints occurred, including 10 cardiovascular deaths and 19 HF hospitalizations. The patients were divided into the improving (n=29), stable (n=27), and worsening LVEF groups (n=42). Among 55 patients with pre-procedural LVEF ≥40%, 17 (31%) had decreased LVEF beyond the LVEF classification immediately after MitraClip. LVEF improvement during the follow-up (HR: 0.05; 95% CI: 0.01-0.49; P=0.010) was identified as an independent prognostic factor, whereas worsening LVEF immediately after MitraClip (HR: 1.78; 95% CI: 0.80-3.96; P=0.154) was not associated with the prognosis. Conclusion MitraClip causes a dynamic change in LVEF beyond the LVEF classification. An acute decrease in LVEF after the procedure was not associated with cardiovascular events, whereas an LVEF improvement during follow-up was strongly associated with a better prognosis.