Journal of the American Society of Echocardiography
Clinical InvestigationSignificance of RV-PA Coupling in Transcatheter Mitral RepairPrognostic Value of Baseline Tricuspid Annular Plane Systolic Excursion to Pulmonary Artery Systolic Pressure Ratio in Mitral Transcatheter Edge-to-Edge Repair
Graphical abstract
Section snippets
Study Population and Outcomes
Our study is based on the Cedars-Sinai Medical Center registry of consecutive mitral TEER procedures performed during the time frame of January 1, 2013, through December 31, 2020. The registry was retrospectively constructed using CS-Link (Epic), a web-based patient medical records platform that contains data regarding demographic characteristics, medical conditions and therapeutics, electrocardiographic tracings, laboratory and imaging results, procedural details, and outcome measures and
Baseline Characteristics of the Study Population
Among 1,055 patients included in the Cedars-Sinai Medical Center registry, 707 underwent isolated, first-time mitral TEER and had data on baseline TAPSE/PASP ratio, the median of which was 0.37 mm/mm Hg (IQR, 0.27-0.55 mm/mm Hg). These patients were followed for a median duration of 448 days (IQR, 86-958 days). Baseline and 1-month echocardiograms were obtained at a median of 16 days (IQR, 5-44 days) before and 33 days (IQR, 28-36 days) after the procedure, respectively.
Compared with the
Discussion
Our study is among the largest, most comprehensive ones to examine the prognostic implications of baseline TAPSE/PASP ratio in real-world mitral TEER patients. Using 0.37 mm/mm Hg as a cutoff value, we found a constellation of worse preprocedural status, intraprocedural hemodynamic effects, and immediate postprocedural results in those with low ratios, who eventually experienced earlier, more frequent deaths and HF hospitalizations at 1 year and along the entire follow-up period.
Conclusion
A low TAPSE/PASP ratio before mitral TEER signifies a higher risk patient profile and, in the case of functional MR, is associated with excessive postprocedural mortality and HF hospitalizations. Further research is needed to reveal the pathways underlying these observations and to assess the clinical implication of incorporating this echocardiographic parameter in the patient selection process.
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Right Ventricular–Pulmonary Arterial Coupling and All-Cause Mortality in Patients with Mitral Annular Calcification–Related Mitral Valve Dysfunction
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2024, International Journal of CardiologyCurrent Percutaneous Approaches to Treat Mitral Valve Regurgitation
2023, Current Treatment Options in Cardiovascular MedicineImpact of concomitant tricuspid regurgitation on outcome after edge-to-edge mitral valve repair
2023, Catheterization and Cardiovascular Interventions
This study was supported in part by the California Chapter of the American College of Cardiology through the Save a Heart Foundation.
Dr. Makkar has received grant support from Edwards Lifesciences; is a consultant for Abbott Vascular, Cordis, and Medtronic; and holds equity in Entourage Medical. Dr. Chakravarty is a consultant, proctor, and speaker for Edwards Lifesciences and Medtronic; is a consultant for Abbott; and is a consultant and speaker for Boston Scientific.