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Background  Percutaneous mitral valve edge‐to‐edge repair ( pMVR ) with a MitraClip is beneficial for the clinical symptoms of patients irrespective of the ejection fraction ( EF ). Nevertheless, the consequences on hemodynamics are poorly understood. Therefore, we used data from noninvasive pressure‐volume loops to investigate the left ventricular (LV) remodeling of patients after  pMVR  dependent on their baseline EF.    Methods and Results  In 130 patients with successful  pMVR , the end‐diastolic pressure‐volume relationship (EDPVR) and end‐systolic pressure‐volume relationship were estimated noninvasively from echocardiographic data. We compared  EDPVR  and end‐systolic pressure‐volume relationship at discharge and follow‐up between patients with a reduced  EF  (<40%) and patients with a mid‐ranged or preserved  EF  (≥40%). Reduced  EF  was present in 71 patients (54%). Mean follow‐up duration was 277±117 days. We observed a significant reduction in degree of mitral regurgitation and an improvement in functional status at follow‐up irrespective of baseline  EF . In patients with a mid‐ranged or preserved  EF , the  EDPVR  and end‐systolic pressure‐volume relationship were shifted leftwards, suggesting an improvement in  LV  function. In contrast, in patients with a reduced  EF ,  EDPVR  and end‐systolic pressure‐volume relationship remained stable, although comparison with the baseline data indicates a rightward shift of the  EDPVR . This indicates that there is no improvement in  LV  function after  pMVR  in patients with reduced EF.    Conclusions  The pMVR is associated with improved clinical symptoms in all patient subgroups. However, it leads to different hemodynamic responses. In patients with mid‐ranged or preserved  EF , we found reverse remodeling with reduced  LV  dilatation and increased contractility. In contrast, in patients with reduced  EF , we observed no reverse remodeling and no improvement in  LV  function.

journal of the american heart association

Distinct Hemodynamic Changes After Interventional Mitral Valve Edge‐to‐Edge Repair in Different Phenotypes of Heart Failure: An Integrated Hemodynamic Analysis