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Updated: Jun 6, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Right Ventricular-to-Pulmonary Artery Uncoupling Following Transcatheter Edge-to-Edge Repair in Ventricular
Daisuke Miyahara1, Masaki Izumo1, Shingo Kuwata1
1Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Background:
The prognostic value of right ventricular-pulmonary artery (RV-PA) coupling in patients with ventricular functional mitral regurgitation (FMR) undergoing mitral transcatheter edge-to-edge repair (M-TEER) is unclear.
Objectives:
The authors aimed to compare hospitalization and survival outcomes between patients with preserved and impaired RV-PA coupling.
Methods:
We analyzed 1,059 patients with ventricular FMR who underwent M-TEER. RV-PA coupling was assessed after M-TEER using the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP). Impaired RV-PA coupling was defined as TAPSE/SPAP <0.36 mm/mm Hg. The primary outcome was a composite of cardiovascular death and hospitalization for heart failure.
Results:
Overall, 30.7% of patients exhibited impaired RV-PA coupling after M-TEER, with minimal improvement in TAPSE and SPAP. Patients with impaired RV-PA coupling at discharge had significantly lower event-free survival than those with preserved RV-PA (P = 0.004). Multivariate Cox regression analysis confirmed impaired RV-PA coupling as an independent predictor of the primary outcome (HR: 1.360; P = 0.029). The association between postprocedural RV-PA coupling and the primary outcome was more profound in patients with pulmonary hypertension (P = 0.047). Diabetes mellitus, impaired RV-PA coupling, lower left ventricular ejection fraction, smaller left ventricular size, and larger left atrial size before M-TEER were independent predictors of impaired RV-PA coupling.
Conclusions:
Impaired RV-PA coupling after M-TEER is independently associated with a higher risk of composite outcomes in patients with ventricular FMR, particularly those with pulmonary hypertension. Therefore, postprocedural assessment of RV-PA coupling may provide valuable prognostic insights and support risk stratification in this population.
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