Left atrial reverse remodeling (LARR) was observed in 29.2% of patients undergoing mitral transcatheter edge-to-edge repair and was independently associated with lower risk of all-cause mortality and heart failure hospitalization, particularly in patients with ventricular secondary mitral regurgitation.
LARR occurred in less than one-third of patients undergoing M-TEER at short-term follow-up.
LARR prevalence differed significantly across mitral regurgitation etiologies, occurring most frequently in primary mitral regurgitation.
LARR was independently associated with a lower risk of the composite outcome of heart failure hospitalization and all-cause mortality in the overall population.
The protective association of LARR with clinical outcomes was particularly strong in patients with ventricular secondary mitral regurgitation.
LARR was not independently associated with lower risk of events in patients with atrial secondary mitral regurgitation or primary mitral regurgitation.
The study used a multicenter echocardiographic registry design to evaluate the prevalence and prognostic role of LARR following M-TEER.
This research suggests that after a minimally invasive heart valve procedure called mitral transcatheter edge-to-edge repair (M-TEER), the left atrium (a chamber of the heart that often becomes enlarged due to a leaky mitral valve) shrinks back toward a more normal size in only about 3 in 10 patients. This shrinkage, called left atrial reverse remodeling (LARR), was defined as at least a 15% reduction in the size of the left atrium measured by echocardiography. The researchers found that LARR was most common in patients whose leaky valve was caused by a problem with the valve itself (primary mitral regurgitation), but least common in patients whose leaky valve was caused by an enlarged or diseased left atrium (atrial secondary mitral regurgitation). Over a follow-up period of up to 4 years, patients who experienced LARR had significantly better outcomes — they were about 41% less likely to be hospitalized for heart failure or die from any cause compared to patients who did not experience LARR. This protective effect was especially pronounced in patients whose leaky valve was due to a weakened heart muscle (ventricular secondary mitral regurgitation), where those with LARR were 57% less likely to experience the combined outcome of hospitalization or death. However, LARR did not appear to offer the same independent survival benefit in patients with primary mitral regurgitation or atrial secondary mitral regurgitation. This research suggests that achieving left atrial reverse remodeling after M-TEER may be an important marker of successful treatment and long-term benefit, particularly for patients with heart muscle-related causes of mitral valve leakage. The findings highlight that not all patients benefit equally from valve repair in terms of cardiac structural improvement, and that the underlying cause of the valve problem may influence how the heart responds to the procedure over time.
Pezzola E, Lupi L, Rubbio A, Sciatti E, Giannini C, Barletta M, et al.. (2026). Prevalence and prognostic role of left atrial reverse remodeling in patients undergoing mitral transcatheter edge-to-edge repair: insights from the Multicenter Echocardiographic Registry of patients undergoing mitral Transcatheter Edge-to-Edge Repair.. Journal of cardiovascular medicine (Hagerstown, Md.). https://doi.org/10.2459/JCM.0000000000001943