Changes in Right Ventricular–to–Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation

“…Our findings are in line with previous studies reporting positive effects on hemodynamic and echocardiographic parameters of RV function and RV to pulmonary arterial coupling 4,11,12 . Importantly, a recent study showed that improved TAPSE/PASP ratio after M-TEER may be associated with better clinical outcome in patients with FMR 13 …”

“…4,11,12 Importantly, a recent study showed that improved TAPSE/PASP ratio after M-TEER may be associated with better clinical outcome in patients with FMR. 13 These considerations remain purely speculative and hypothesis-generating because the study is limited by a small sample size from a single center. Larger prospective studies are needed to validate the present data and to evaluate the prognostic significance of PV flow changes.…”

Application of an echocardiographic index to characterize right ventricular–pulmonary arterial coupling in heart failure

“…110 Most of the patients (66%) had better TAPSE/PASP in the short-term post-operatively; this improvement was noticeable from the baseline clinical and echocardiographic indicators and the differential pressure at the mitral valve post-operatively. 110 Long-term follow-up (median: 584 days) showed that TAPSE/PASP reversal reduced death risk (HR = 0.65; 95% CI: 0.42-0.92; P = 0.017) and initial NYHA classification and HF readmission rates. 110 In a study involving 457 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), Sultan et al 34 found that TAPSE/PASP was an independent predictor of all-cause mortality, a dose-response relationship (lowest vs. highest quartile, HR = 2.21; 95% CI: 1.07-4.57; P = 0.03) existed between its quartiles and survival, and even after adjusting for potential confounders, including AF and LVEF, this link remained statistically significant.…”

“…110 Long-term follow-up (median: 584 days) showed that TAPSE/PASP reversal reduced death risk (HR = 0.65; 95% CI: 0.42-0.92; P = 0.017) and initial NYHA classification and HF readmission rates. 110 In a study involving 457 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), Sultan et al 34 found that TAPSE/PASP was an independent predictor of all-cause mortality, a dose-response relationship (lowest vs. highest quartile, HR = 2.21; 95% CI: 1.07-4.57; P = 0.03) existed between its quartiles and survival, and even after adjusting for potential confounders, including AF and LVEF, this link remained statistically significant. Adamo et al 111 reported that TAPSE/ PASP < 0.36 mm/mmHg was associated with a greater risk of all-cause mortality at 6 months in 377 patients undergoing TAVR (17.3% vs. 5.3%; aHR = 2.66; P = 0.041), and TAPSE/ PASP had better prognostic predictive power than TAPSE and PASP alone and was independent of surgical risk score.…”

Significance of Right Ventricular Myocardial Work for Clinical Improvement in Heart Failure with Reduced Ejection Fraction Patients after Transcatheter Edge-To-Edge Repair

“…The RV-to-pulmonary artery (RV-PA) coupling, non-invasively gauged via echocardiography by analyzing the ratio between tricuspid annular plane systolic excursion and pulmonary artery systolic pressure (TAPSE/PASP), can be viewed as an approximate for the RV lengthforce relationship and has been found to hold clinical and prognostic significance in HF demographics [13][14][15][16]. Adamo and his colleagues found that TAPSE/PAPs is a major predictor of outcome in patients with SMR undergoing TEER [17]. Given its consideration for afterload, RVMW offers insights into RV-PA coupling, potentially offering a more nuanced understanding of RV systolic function.…”