Estimating Left Atrial Pressure Using Diastolic Cutoff Values After Transcatheter Mitral Valve Edge-to-Edge Repair

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Mitral  regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life and heart failure. Transcatheter edge-to-edge repair (TEER) has become an important treatment for symptomatic patients with MR who are high surgical risk.  TEER was associated with reductions in mortality and heart failure hospitalization and subsequent geometric changes of the left ventricle in patients with LV dysfunction. Mitral valve transcatheter edge-to-edge repair (M-TEER) has imposed as a non-surgical treatment option. The presented study investigated the early post-procedural impact of M-TEER on classic diastolic function parameters. Although no stastistically significant change in E wave velocity was observed, it identified a trend towards higher E wave alongside a statistically significant decrease in e′ velocity compared to baseline TTE. This resulted in a significantly higher E/e′ ratio post-procedure. Notably, LAVI remained unchanged in the short term. The influence of M-TEER on LAVI is more nuanced, with some studies finding no significant changes and others reporting volume reductions only in long-term follow-up. In line with these findings, this study observ„„ed no significant change in LAVI within the short-term. It is important that this study was investigated diastolic cutoff values for predicting post-M-TEER LAP in both normal and abnormal LVEF patients and this represents the first attempt to achieve this. This study demonstrates a significant impact of M-TEER on diastolic parameters, particularly early mitral inflow, velocities at mitral level, and the resulting E/e′ ratio. 

The bibliography presented includes recent titles. The article is well written and documented. I recommend it for publication. 

Author Response

Thank you for your valuable time and effort in reviewing our manuscript titled "Improving Aortic Valve Area Assessment: Correcting CT-Derived Measurements for LVOT Ellipticity."

We greatly appreciate your positive feedback and kind words regarding the article's quality, documentation, and the recency of our bibliography.

We are grateful for your recommendation for publication. Your insights affirm the importance and relevance of our findings.

 

Reviewer 2 Report

Comments and Suggestions for Authors

The article titled " jcm-3667670_Estimating Left Atrial Pressure Using Diastolic Cutoff Values After Transcatheter Mitral Valve Edge-to-Edge Repair" is submitted for consideration in the "Cardiology" of the journal "JCM". This study evaluates the impact of transcatheter mitral valve edge-to-edge repair (M-TEER) on diastolic parameters and the estimation of left atrial pressure (LAP) following the procedure. Based on a sample of 240 patients, M-TEER was shown to increase the E/e’ ratio. Specific cut-off values for E wave velocity and E/e’ reliably predicted normal LAP depending on left ventricular ejection fraction. These non-invasive measures demonstrated high predictive accuracy but require further clinical validation. The content is therefore appropriate for inclusion in this section.

Comments:

The title accurately reflects and communicates the content of the article.

The abstract is well-structured, presenting the study’s key points and serving its purpose as an informative summary.

The keywords should be reviewed and aligned with MeSH terminology.

The introduction effectively outlines the conceptual framework and highlights the relevance of echocardiographic assessment of left ventricular diastolic function, supported by appropriate references. However, the standard structure of a scientific introduction typically ends with a clear and concise statement of the study’s hypothesis and objectives. In this case, the objective appears prematurely (lines 44–46) and again later (lines 68–70); these should be consolidated and moved to the end of the introduction.

Materials and Methods:The study is described as retrospective; however, given the close monitoring and follow-up of patients during the entire intrahospital period, the authors should consider whether it would be more accurately defined as a retrospective cohort study.

It is essential to state explicitly that all patients underwent the same type of follow-up.

Alongside the mention that the study received ethical approval, the approval number from the ethics committee must be provided.

The procedural description is clear; however, the timing of follow-ups and patient evaluations is not specified. Please clarify the schedule of follow-up assessments and ensure that evaluations were performed at consistent time points.

Statistical Analysis: The statistical analysis is appropriate and clearly described.

Results:The results are clearly presented and well-supported by the accompanying tables.

Discussion:The discussion interprets the findings thoughtfully. Although the results are not statistically significant, they show an encouraging trend, and the authors propose preliminary cut-off values. These should be validated in prospective studies before clinical application.

The limitations section mentions the challenges of interpreting the results. However, I believe the discussion is well-structured and the single-center nature of the study should not be seen as a major limitation, as it ensures protocol consistency. Nonetheless, a multicenter study would indeed increase statistical power.

The conclusion of the discussion should more explicitly highlight the need for future studies, building upon the achievements of this work, to confirm the clinical utility of LAP estimation.

Conclusion:The conclusion appropriately summarizes the findings and emphasizes the need for further research to validate the proposed approach before its implementation in clinical practice.

Author Response

Please see the attachment

Author Response File: Author Response.pdf