Does right ventricular performance reflect the severity of mitral regurgitation? a clinical evaluation of the tapse/pasp ratio

Abstract Introduction Mitral regurgitation (MR) is a common valvular disorder that increases left ventricular filling pressures, leading to volume overload in the left atrium and secondary elevation of pulmonary vascular resistance. With the development of pulmonary hypertension, right ventricular function is also affected, directly impacting prognosis. In this study, we aimed to evaluate the relationship between the severity of MR and the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio, an indicator of right ventricular systolic performance. Purpose To investigate whether the TAPSE/PASP ratio is associated with the severity of mitral regurgitation. Methods This retrospective observational study included 53 patients diagnosed with MR who underwent transesophageal echocardiography (TEE) between 2024 and 2025. Biochemical, demographic, and echocardiographic data were retrospectively obtained from the hospital information system. MR severity was classified into moderate and severe based on effective regurgitant orifice area (EROA) and regurgitant volume (RV) measured during TEE. Patients with mild MR were excluded. There were 27 patients in the moderate MR group and 26 in the severe MR group. The TAPSE/PASP ratio was calculated for each patient, and its relationship with MR severity was analyzed. Independent samples t-test was used for continuous variables and chi-square test for categorical variables. The predictive value of the TAPSE/PASP ratio for severe MR was assessed using ROC curve analysis, including sensitivity, specificity, and AUC. Results A total of 53 patients were included. Baseline demographic, clinical, and echocardiographic characteristics are summarised in Table 1. No statistically significant differences were found between the moderate and severe MR groups regarding baseline features. The mean TAPSE/PASP ratio was 0.67 ± 0.18 in the moderate MR group and significantly lower in the severe MR group at 0.33 ± 0.11. Normality of the data was confirmed by the Shapiro-Wilk test (p 0.05), and the difference between groups was statistically significant (p 0.001). ROC analysis revealed an AUC of 0.953. The optimal cut-off value was determined to be 0.514 (sensitivity: 96.1%, specificity: 81.5%) (Figure 1). Conclusions The TAPSE/PASP ratio showed a strong and significant association with the severity of mitral regurgitation. It was significantly lower in patients with severe MR. ROC analysis demonstrated that this ratio has high sensitivity and specificity for predicting severe MR. These results suggest that the TAPSE/PASP ratio may serve as a practical, reliable, and non-invasive marker in assessing MR severity. Further studies with larger patient populations are needed to validate these findings.demographic and clinical characteristics roc curve analysis of the tapse/pasp rat