Left ventricular reverse remodeling (LVRR), defined as reversal of left ventricular (LV) dilation and dysfunction, represents a therapeutic goal in heart failure (HF). Data from the EXPAND and EXPAND G4 studies were pooled in a cohort analysis to evaluate the incidence, predictors, and outcomes of early LVRR after mitral transcatheter edge-to-edge repair(M-TEER). The EXPANDed cohort included 2,205 patients, with early LVRR defined as a >10% reduction in LV dimension or volume at 30 days, assessed by independent echocardiographic core laboratories. The study was published in the ESC Heart Failure.

Among secondary mitral regurgitation (SMR) patients (n=527), early LVRR occurred in 64.1% (n=338). Among SMR patients (n=527), early LVRR occurred in 64.1% (n=338). At 1 year, the composite outcome of all-cause death or HF hospitalization was lower in patients with early LVRR compared with those without (24.7% vs 35.9%, p=0.009). Mitral regurgitation reduction, functional improvement (≥78% NYHA class ≤II), and quality-of-life gains (~20-point improvement in KCCQ-OS) were similar in both groups.

Independent associations with early LVRR included hypertension (odds ratio [OR] 1.96, p=0.004), absence of prior cardiac surgery (OR 0.51, p=0.002), and smaller LV end-systolic volume (OR 0.81, p=0.002). In primary mitral regurgitation (PMR) patients (n=536), early LVRR occurred in 73.0% (n=391). The composite outcome of all-cause mortality or HF hospitalization was similar between groups (14.5% vs 17.1%, p=0.47). However, among PMR patients with dilated ventricles, early LVRR was associated with lower all-cause mortality (3.8% vs 14.0%, p=0.028).\

Early LVRR was frequently observed following M-TEER with consistent MR reduction and symptomatic benefit. In SMR, early LVRR was associated with improved clinical outcomes, suggesting that early LVRR may reflect favorable remodeling after M-TEER.