943 THE RIGHT VENTRICULAR-ARTERIAL COUPLING AS AN INDICATOR OF PROGNOSIS IN PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION UNDERGOING TRANSCATHETER “EDGE-TO-EDGE“ VALVE REPAIR

Abstract

Abstract Aims Patients affected by severe functional Mitral Regurgitation (MR) complaining symptoms despite optimal medical therapy should undergo intervention. When the surgery, the gold standard, is not indicated due to high surgical risk, the transcatheter edge-to-edge repair (TEER) should be considered, if feasible. In patients undergoing TEER, the clinical outcome is not always optimal and strongly correlates to the patient's clinical conditions, so a correct selection of the patients is essential. In this regard, some studies have evaluated the RV-PA coupling as an important predictor of outcome in patients with Heart Failure (HF). In clinical practice, RV-pulmonary artery (PA) coupling could be estimated in a non-invasive way through the relationship between TAPSE (systolic excursion of the annular plane of the tricuspid valve) /PAPs (systolic pressure of the pulmonary artery) ratio that gives information about the state of contractility and adaptability to the load of the RV. In this study, we sought to evaluate how the TAPSE /PAPs ratio at baseline may improve prognostic stratification in patients undergoing TEER with the MitraClip system. Methods and Results Data from 236 patients with symptomatic, moderate to severe functional MR, subjected to implantation of MitraClip between March 2012 and June 2021, were obtained from the University's MITRA-CTV, multicenter observational register comprising data from the Magna Graecia University of Catanzaro (Italy), the University of Turin (Italy) and the University of Vigo (Spain). The median follow-up was 686 days (IQR 393-1131 days), with a 1-year follow-up in 224 of 236 (95%) patients. We divided the population into two groups based on the median value of the ratio TAPSE / PAPs ≤ 0.35 and TAPSE / PAPs> 0.35. The primary endpoint of this study includes Re-hospitalization for HF and Death from all causes at one-year follow-up. At Cox regression analysis, Hospital stay> 10 days (HR 1.67, 95% CI [1.03-2.77], p = 0.039) and the TAPSE / PAPs ratio ≤ 0.35 (HR1.58, 95% CI [1, 01-2.48], p = 0.0488) independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan Meier analysis, a TAPSE / PAPs ratio of ≤ 0.35 was related to an increased incidence of the primary endpoint of Rehospitalization for HF and Death (HR 1.54, 95% CI [ 1-2.41], p = 0.0464). Conclusion In our study, the right ventricular-arterial coupling, estimated through TAPSE/PAPs Ratio, was identified as a predictor of outcome in patients with severe functional MR undergoing TEER.