Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

Abstract

Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA). Methods: Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality. Results: Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, p = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately. Conclusions: TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.

Prognostic implication of noninvasive right ventricle-to-pulmonary artery coupling in chronic thromboembolic pulmonary hypertension

“…Subsequently, the functional and prognostic relevance of TAPSE/PASP has also been identified in pulmonary arterial hypertension (PAH), 6 PAH associated with connective tissue diseases, 7 , 8 PH secondary to chronic lung disease, 9 acute PE, 10 and patients undergoing transcatheter valve procedures. 11 , 12 Nevertheless, the prognostic implication of TAPSE/PASP remains unclear in patients with CTEPH.…”

Right ventricular–pulmonary artery coupling in cardiac resynchronization therapy: evolution and prognosis

“…Invasive measurements of RV‐PA coupling are impractical for routine clinical use, but can be reliably estimated by the echocardiographic ratio of TAPSE and PASP 8,17 . This non‐invasive index of RV–PA coupling has demonstrated prognostic value in various cardiovascular diseases 19–22 …”

“…Although the TAPSE/PASP ratio has been shown to predict outcomes in various cardiovascular conditions, 19–22 it has never been thoroughly evaluated in patients with HF and reduced LVEF undergoing CRT implantation. In a study of 54 CRT recipients, Deaconu et al .…”

“…8,17 This non-invasive index of RV-PA coupling has demonstrated prognostic value in various cardiovascular diseases. [19][20][21][22] Prognostic implications of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio in cardiac resynchronization therapy recipients…”

“…12,16 The abovementioned studies underpin the use of RV-PA coupling parameters in HF patients. Although the TAPSE/PASP ratio has been shown to predict outcomes in various cardiovascular conditions, [19][20][21][22] never been thoroughly evaluated in patients with HF and reduced LVEF undergoing CRT implantation. In a study of 54 CRT recipients, Deaconu et al demonstrated that the TAPSE/PASP ratio was linked to both CRT response (defined as ≥15% reduction in LV end-systolic volume) as well as cardiovascular events.…”