Impact of right ventricular to pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair

Abstract

Abstract Background Right ventricular to pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce. Methods Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed using a composite endpoint of heart failure hospitalization and death. Results Between April 2018 to January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio <0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p<0.01), both in patients with primary (64 vs. 91%, p=0.01) and secondary MR (54 vs. 76%, p=0.03). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio <0.36 was independently associated with outcome (adj.HR 2.74, 95%CI: 1.17-6.43, p=0.02). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ +3mm, PASP: ∆ -10mmHg, p for both <0.01), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥II: 77 to 54%, p<0.01). Conclusion TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.Graphical Abstract