Key result
A baseline TAPSE/PASP ratio ≤0.36 was associated with higher 1-year mortality and heart failure hospitalization after MitraClip compared to >0.36 (39.4% vs 14.8%; HR 3.87, 95% CI 1.83-8.22; p≤0.001).
Why the study?
Impaired right ventricle to pulmonary artery coupling marks RV dysfunction, but its prognostic impact in patients with mitral regurgitation treated with MitraClip required evaluation.
Does a baseline TAPSE/PASP ratio ≤ 0.36 predict increased all-cause mortality and heart failure hospitalization in patients with mitral regurgitation treated with MitraClip?
Cohort (n=165)
Does a baseline TAPSE/PASP ratio ≤ 0.36 predict increased all-cause mortality and heart failure hospitalization in patients with mitral regurgitation treated with MitraClip?
Hazard Ratio: 3.87 (95% CI 1.83–8.22)
Absolute Event Rate: 39.4% vs 14.8%
p-value: p=≤ 0.001
A baseline TAPSE/PASP ratio ≤ 0.36 is a strong independent predictor of 1-year mortality and heart failure hospitalization in patients undergoing MitraClip for mitral regurgitation.
Lower TAPSE/PASP may refine risk stratification before MitraClip; leaves open whether RV-PA coupling modification alters outcomes.
OBJECTIVES: To evaluate the prognostic impact of baseline tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio, as an expression of the right ventricle-pulmonary artery (RV-PA) coupling, in patients with mitral regurgitation (MR) treated with the MitraClip. BACKGROUND: Impaired RV to PA coupling is considered a marker of RV dysfunction. METHODS: From February 2016 to February 2020, a total of 165 patients were evaluated and stratified in two groups according to a prespecified value of TAPSE/PASP ratio ≤ 0.36. RESULTS: The median patients' age was 79 (men: 62.4%). Sixty-three patients (38.1%) presented TAPSE/PASP ≤ 0.36 and were then compared with patients with TAPSE/PASP > 0.36. Functional MR etiology was more frequent in TAPSE/PASP ≤ 0.36 (71.4%; p = 0.046). Acute technical success was achieved in 92.7% of the population, without any significant difference between the two groups of study and with sustained results at 30-day (device success: 85.5%; procedural success: 84.8%). On multivariate Cox regression analysis, after correction for body mass index, chronic kidney disease and left ventricle ejection fraction ≥30% but <50%, TAPSE/PASP ≤ 0.36 remained a sustained predictor of mortality and hospitalization for heart failure at one year after MitraClip (hazard ratio: 3.87; 95% confidence interval: 1.83-8.22; p ≤ 0.001). Kaplan-Meier all-cause mortality and heart failure hospitalization rates at one year were consequently higher in patients with TAPSE/PASP ≤ 0.36 (39.4% vs. 14.8%; log-rank p ≤ 0.001). CONCLUSION: Baseline TAPSE/PASP ratio seems independently associated with all-cause mortality and heart failure hospitalization after MitraClip both in functional and degenerative MR.
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Rubbio et al. (2021) conducted a cohort in mitral regurgitation (n=165). TAPSE/PASP ratio ≤ 0.36 vs. TAPSE/PASP > 0.36 was evaluated on all-cause mortality and heart failure hospitalization (HR 3.87, 95% CI 1.83-8.22, p=≤ 0.001). A baseline TAPSE/PASP ratio ≤0.36 was associated with higher 1-year mortality and heart failure hospitalization after MitraClip compared to >0.36 (39.4% vs 14.8%; HR 3.87, 95% CI 1.83-8.22; p≤0.001).
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