Impaired right ventricular-pulmonary artery coupling after M-TEER was independently associated with a higher risk of cardiovascular death and heart failure hospitalization (HR 1.360; P=0.029).
Cohort (n=1,059)
Does impaired RV-PA coupling after M-TEER predict cardiovascular death and heart failure hospitalization in patients with ventricular FMR?
Impaired RV-PA coupling after M-TEER is an independent predictor of cardiovascular death and heart failure hospitalization in patients with ventricular functional mitral regurgitation, particularly those with pulmonary hypertension.
Hazard Ratio: 1.36
p-value: p=0.029
BACKGROUND: The prognostic value of right ventricular-pulmonary artery (RV-PA) coupling in patients with ventricular functional mitral regurgitation (FMR) undergoing mitral transcatheter edge-to-edge repair (M-TEER) is unclear. OBJECTIVES: The authors aimed to compare hospitalization and survival outcomes between patients with preserved and impaired RV-PA coupling. METHODS: We analyzed 1,059 patients with ventricular FMR who underwent M-TEER. RV-PA coupling was assessed after M-TEER using the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP). Impaired RV-PA coupling was defined as TAPSE/SPAP <0.36 mm/mm Hg. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure. RESULTS: Overall, 30.7% of patients exhibited impaired RV-PA coupling after M-TEER, with minimal improvement in TAPSE and SPAP. Patients with impaired RV-PA coupling at discharge had significantly lower event-free survival than those with preserved RV-PA (P = 0.004). Multivariate Cox regression analysis confirmed impaired RV-PA coupling as an independent predictor of the primary outcome (HR: 1.360; P = 0.029). The association between postprocedural RV-PA coupling and the primary outcome was more profound in patients with pulmonary hypertension (P = 0.047). Diabetes mellitus, impaired RV-PA coupling, lower left ventricular ejection fraction, smaller left ventricular size, and larger left atrial size before M-TEER were independent predictors of impaired RV-PA coupling. CONCLUSIONS: Impaired RV-PA coupling after M-TEER is independently associated with a higher risk of composite outcomes in patients with ventricular FMR, particularly those with pulmonary hypertension. Therefore, postprocedural assessment of RV-PA coupling may provide valuable prognostic insights and support risk stratification in this population.
Miyahara et al. (Mon,) conducted a cohort in Ventricular functional mitral regurgitation (FMR) (n=1,059). Impaired RV-PA coupling (TAPSE/SPAP <0.36 mm/mm Hg) vs. Preserved RV-PA coupling was evaluated on Composite of cardiovascular death and hospitalization for heart failure (HR 1.360, p=0.029). Impaired right ventricular-pulmonary artery coupling after M-TEER was independently associated with a higher risk of cardiovascular death and heart failure hospitalization (HR 1.360; P=0.029).