Echocardiographic and invasive RV-PA coupling predict mortality after edge-to-edge repair for degenerative mitral...

Right ventricular-pulmonary artery coupling and the pulmonary artery pulsatility index (PAPi) have emerged as potential prognostic markers in cardiovascular disease. Their utility in patients with degenerative mitral regurgitation (DMR) undergoing transcatheter mitral edge-to-edge repair (M-TEER) remains unclear.

To evaluate the prognostic value of RV-PA coupling and PAPi in DMR patients treated with M-TEER.

This retrospective single-center study included 293 patients with DMR undergoing M-TEER between 2012 and 2022. RV-PA coupling was assessed by echocardiographic tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP_echo) and, in a subset, invasively (TAPSE/sPAP_invasive). PAPi was calculated as (sPAP-diastolic PAP) / right atrial pressure. The primary endpoint was all-cause mortality at 2 years; the secondary endpoint was a composite of mortality or heart failure hospitalization.

RV-PA uncoupling (TAPSE/sPAP_echo < 0.307 mm/mmHg) was associated with higher 2-year mortality (52.2% vs. 22.2%; HR = 2.64; p < 0.001) and composite events (56.4% vs. 30.1%; HR = 2.22; p = 0.0023). Similar results were observed with invasively derived TAPSE/sPAP (cut-off < 0.315 mm/mmHg). In contrast, PAPi < 3.65 was not associated with outcomes. TAPSE alone showed no prognostic significance.

RV-PA coupling, but not PAPi, predicts mortality and heart failure rehospitalization following M-TEER in DMR patients. These findings highlight the value of RV-PA coupling indices for risk stratification and support their routine use in preprocedural assessment.