https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Sana Krankenhaus Cham Innere Medizin II Cham, Deutschland; 3Krankenhaus Barmherzige Brüder Regensburg Klinik für Kardiologie Regensburg, Deutschland; 4Klinikum St. Marien Klinik für Innere Medizin I Amberg, Deutschland; 5Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland
Background
Derangements of right ventricular-pulmonary arterial (RV-PA) coupling are associated with adverse outcomes in different entities of heart failure and valvular heart disease. While non-invasively assessed indices of RV-PA coupling have been demonstrated to predict outcome after transcatheter edge-to-edge repair (M-TEER) in patients with functional ventricular mitral regurgitation (MR), their prognostic value in degenerative and atrial MR is yet to be defined.
Methods and results
We enrolled 260 patients undergoing M-TEER for symptomatic moderate-to-severe or severe MR in a prospective single-center study. RV-PA coupling was assessed by echocardiography as the ratio of tricuspid annular plane systolic excursion to estimated pulmonary systolic artery pressure (TAPSE/PASP). MR etiology was degenerative in 35.0%, ventricular in 40.0%, and atrial in 25.0% of patients. Reduction to MR grade II or less was achieved in 95.3% of patients. Mean baseline RV-PA coupling was markedly reduced with 0.48 ± 0.23 mm/mmHg and did not differ between MR etiologies. Using receiver operating characteristics-derived cut-offs of 0.54 for degenerative and 0.28 mm/mmHg for ventricular etiology, RV-PA uncoupling at baseline strongly predicted mortality or hospitalization for heart failure after M-TEER during follow-up (ventricular HR 1.93 [1.05-3.56], p=0.035; degenerative HR 7.87 [1.04-59.64], p=0.046). In contrast, baseline RV-PA coupling was not associated with outcome in patients with atrial MR. At follow-up one to three months after the procedure, an improvement in RV-PA coupling was observed regardless of MR etiology (degenerative 0.47 ± 0.18 vs. 0.55 ± 0.21, p<0.001; ventricular 0.45 ± 0.18 vs. 0.55 ± 0.22, p<0.001; atrial 0.48 ± 0.22 vs. 0.56 ± 0.22 mm/mmHg, p=0.007). Yet, normalization of RV-PA coupling was not associated with improved clinical outcome after M-TEER.
Conclusions
RV-PA coupling at baseline predicts clinical outcome after M-TEER in both ventricular and degenerative MR and may be helpful for identifying patients with increased risk for adverse events. Successful interventional therapy of MR is associated with improvement of RV-PA coupling regardless of MR etiology.