{
  "abstract": "Introduction Mitral regurgitation (MR) causes left atrial (LA) & left ventricular (LV) dilatation, with subsequent LV hypertrophy 1. Primary MR (PMR) is due to a primary lesion of the mitral valve (MV) leaflet(s)2.In treating PMR, MV repair (MVr) is recommended over MV replacement (MVR) if possible2. Transcatheter edge-to-edge repair (TEER) is reserved for those with high surgical risk. MV intervention (MVI) causes significant reductions in LA and LV size, with cardiovascular magnetic resonance imaging (CMR) considered the gold standard to assess LA and LV size and function. Prior work shows similar reverse remodelling following MVr or MVR, but comparison with patients post-TEER has not been assessed before with CMR3.This study assessed reverse remodelling processes in patients with PMR underdoing MVr, MVR or TEER using CMR, to assess differences post MVI.Methods This was a prospective single centre study of patients with severe PMR listed for MVI. Exclusion criteria included secondary MR, significant aortic valve disease, and New York Heart Association class IV. Severe PMR was confirmed on echocardiography prior to recruitment, and type of MVI decided by the local multidisciplinary Heart Team 2. Patients underwent 6-minute walk test (6MWT) and CMR within 1-month prior to MVI, and 6-months after. CMR protocol included cine and phase contrast imaging.Results One hundred and one patients were recruited. Patients undergoing TEER were significant older, with higher rates of diuretic use. TEER patients had higher surgical risk scores, and worse baseline 6MWT ( table 1).There were no significant differences between the groups in LV size or function, as per indexed LV end-diastolic volume (LVEDVi) and effective forward LV ejection fraction (EF-LVEF) (table-1). There were no significant differences in LA size or MR severity in the groups. Patients undergoing TEER had significantly more tricuspid regurgitation (TR), and larger right atria (RA).Patients underwent MVR (n=40), MVr (n=43) and TEER (n=18). Patients post-TEER had significantly more residual MR compared to MVR or MVr (table-2). Despite this there were no significant differences in LVEDVi, LVMI or EF-LVEF between the 3 cohorts. LA and RA sizes were significantly larger in the TEER cohort, with significantly more TR at visit 2.All cohorts had significant reductions in LVEDVi and EF-LVEF post-MVI (table 2). 6MWT significantly improved in all groups. All groups had significant reductions in MR severity, but only MVR and MVr cohorts had significant reductions in LA size. No MVI led to a significant change in RA size.Conclusion This study demonstrates patients undergoing TEER had significantly more residual MR than with other MVI. Despite higher levels of residual MR with TEER, the LV reverse remodelling post-MVI is very similar regardless of MVI. LA reverse remodelling was only seen after MVR or MVr. Larger studies are required, but this may have implications for future TEER use.Abstract 245 Table 1Characteristics of patients with severe mitral regurgitation, having mitral valve replacement (MVR), mitral valve repair (MVr), and transcatheter edge-to-edge repair (TEER). a: significant difference between MVR & MVr. b: significant difference between MVR & TEER. c: significant difference between MVr & TEERMVR(n=40)MVr(n=43)TEER(n=18)PvalueAge69[66,71]b65[62,68]c83[81,85]<0.0001Diuretic15(38%)21(49%)16(89%)0.0013STS mortality2.02[0.86,1.65]b1.26[0.86,1.65]c4.78[3.71,5.85]<0.00016 min walk test,m364[340,389]b358[330,387]c244[202,286]<0.0001Reduction from V1-V2: 6 min walk test,m (P value)<0.0001<0.00010.014LVEDVi,mL/m2126[117,134]130[120,140]121[107,134]0.52Effective forward LVEF (EF-LVEF),%26[23,29]26[24,29]27[23,31]0.86LVmass index,g/m2 61[56,66]62[58,67]66[58,75]0.51LAvolume,ml/m299[87,110]92[82,101]110[84,136]0.22RAmax area,cm2/m214.6[13.3,15.8]b14.0[12.8,15.2]c18.2[15.8,20.7]0.0012MRvolume,ml71[61,81]75[66,84]57[44,70]0.10TRvolume,ml15[10,19]b13[10,16]c28[18,38]0.0007Abstract 245 Table 2Cardiac MR parameters at visit 2 in patients with severe mitral regurgitation, after differing mitral valve interventionMVR V2(n=40)MVr V2(n=43)TEER V2(n=18)PvalueLVEDVi,mL/m289[82,96]92[83,100]99[84,113]0.42EF-LVEF,%39[36,42]37[34,40]38[31,45]0.62LV mass index,g/m2 57[53,62]56[51,60]62[51,72]0.41LAvolume,ml/m265[55,75]b59[48,70]c109[83,135]<0.0001RAmax area,cm2/m214.1[12.7,15.4]b13.5[12.3,14.8]c18.8[16.3,21.3]<0.0001TRvolume,ml12[9,15]b10[7,14]c21[13,30]0.0062MRvolume,ml12[10,15]a,b19[15,23]c30[21,40]<0.0001Reduction from V1-V2: LV EDVi,mL/m2 (P value)<0.0001<0.0001<0.0001Reduction from V1-V2: EF-LVEF,% (P value)<0.0001<0.00010.0002Reduction from V1-V2: LAvolume, ml/m2 (P value)<0.0001<0.00010.88Reduction from V1-V2: RAarea,cm2/m2 (P value)0.390.290.39Reduction from V1-V2: MRvolume,ml (P value)<0.0001<0.0001<0.0001Reduction from V1-V2: TRvolume,ml (P value)0.190.210.22",
  "authors": [
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Henry Procter"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom"
      ],
      "name": "Mehak Asad"
    },
    {
      "affiliations": [
        "Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom"
      ],
      "name": "Thomas Craven"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Mira Gorecka"
    },
    {
      "affiliations": [
        "Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, United Kingdom"
      ],
      "name": "Pei Chew"
    },
    {
      "affiliations": [
        "Wythenshawe Hospital, Manchester, United Kingdom"
      ],
      "name": "Laura Dobson"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom",
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Marilena Giannoudi"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Sindhoora Kotha"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Christopher Malkin"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom"
      ],
      "name": "Michael Cunnington"
    },
    {
      "affiliations": [
        "Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom",
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom"
      ],
      "name": "Daniel Blackman"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom",
        "Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom"
      ],
      "name": "Peter Swoboda"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom"
      ],
      "name": "Sven Plein"
    },
    {
      "affiliations": [
        "Baker Heart and Diabetes Institute, Melbourne, Australia",
        "University of Melbourne, Melbourne, Australia"
      ],
      "name": "Eylem Levelt"
    },
    {
      "affiliations": [
        "University of Leeds, Leeds institute of cardiovascular and metabolic medicine, Leeds, United Kingdom",
        "Baker Heart and Diabetes Institute, Melbourne, Australia",
        "Monash University, Melbourne, Australia",
        "University of Melbourne, Melbourne, Australia"
      ],
      "name": "John Greenwood"
    }
  ],
  "title": "245 Cardiac reverse remodelling in chronic primary mitral regurgitation: comparison of mitral valve replacement, repair, and transcatheter edge-to-edge repair",
  "uid": "1ceeef17-3178-5a8d-a53d-2422725b385c"
}