Prognostic value of the TAPSE/PASP-ratio in patients with severe mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair

BACKGROUND: Transcatheter edge-to-edge mitral valve repair (M-TEER) represents an effective treatment modality for high-grade mitral valve regurgitation. The right ventricle (RV) to pulmonary artery (PA) coupling ratio has been indicated as a marker of right ventricular dysfunction (RVD), but evidence among M-TEER patients remains inconsistent to date due to divergent definitions. We therefore aimed to shed light on the impact of RV-PA uncoupling on survival following M-TEER. METHODS: Data from all patients who underwent M-TEER and provided sufficient echocardiographic data were investigated. RV-PA uncoupling was defined as the ratio of tricuspid annular pulse systolic excursion (TAPSE) and to the Doppler echocardiographic-derived pulmonary artery systolic pressure (D-PASP) < 0.37 mm/mmHg. The difference in long-term survival between patients with and without RV-PA uncoupling were analyzed via the Kaplan-Meier method, and independent predictors of mortality were identified via uni- and multivariable Cox regression analyses. RESULTS: A total of 158 patients were eligible for analysis, and RV-PA uncoupling was present in 32.3% of the patients (51/158). Patients with RV-PA uncoupling presented significantly advanced congestive heart failure stages. While M-TEER was performed equally safely in patients with RV-PA uncoupling (odds ratio for procedural success: 0.95, 95% confidence interval [CI] 0.29-2.77, p = 0.9), their long-term survival three years after M-TEER was significantly worse (50.9% (26/51) vs. 61.7% (66/107), p = 0.01). In this regard, a TAPSE/D-PASP ratio < 0.37 mm/mmHg proved to be a more consistent discriminator of long-term survival than a TAPSE < 18 mm alone. CONCLUSION: RV-PA uncoupling, defined as a TAPSE/D-PASP ratio of < 0.37 mm/mmHg, is a feasible and reproducible parameter, which also serves as a marker for advanced congestive heart failure and worse survival outcomes.