Advanced and novel echocardiographic right ventricular function parameters predict outcomes after percutaneous mitral valve repair
R Mistrulli, I R Ilaria Rubino, T S Tatyana Storozhenko, P P Pasquale Paolisso, E B Emanuele Barbato, G V C Guy Van Camp, M V Marc Vanderheyden, M P Martin PenickaAbstract
Background
Mitral regurgitation (MR) is a prevalent valvular disease, and mitral transcatheter edge-to-edge repair (M-TEER) is recommended for patients with severe MR who are inoperable or at high surgical risk. While M-TEER has shown comparable outcomes to conventional surgery, over 10% of patients experience mortality, and nearly 15% are rehospitalized for heart failure within the first year. This study aimed to assess the prognostic value of advanced right ventricular (RV) function parameters in predicting major adverse cardiovascular events (MACE) following M-TEER using the MitraClip system.
Methods
This retrospective cohort study analyzed 60 patients who underwent M-TEER between March 2015 and November 2023. Echocardiographic assessments were performed at baseline, post-procedure (before discharge), and at 6-month follow-up. Advanced echocardiographic parameters, including tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP), TAPSE normalized to right ventricular end-diastolic area (TAPSE/RVAD), and TAPSE normalized to right ventricular end-systolic area (TAPSE/RVAS), were evaluated for their predictive value for MACE. Right ventricular myocardial work (RVMW) indices, including RV global work index (RVGWI), RV global constructive work (RVGCW), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE), were also analyzed. MACE, including all-cause death, heart failure hospitalization, and stroke, were assessed at one year of follow-up.
Results
TAPSE/PASP, TAPSE/RVAD, and TAPSE/RVAS were significant predictors of MACE in both univariate and multivariate analyses. Pre-procedural TAPSE/RVAD (coefficient estimate: 0.697, 95% CI: 0.569–0.853, p=0.001) with a cut-off value of 1.1, and pre-procedural TAPSE/RVAS (coefficient estimate: 0.823, 95% CI: 0.731–0.926, p=0.002) with a cut-off value of 1.5, were strong independent predictors of MACE. TAPSE/PASP also remained an independent predictor (p=0.0247) with a cut-off value of 0.35. The AUC values from the multivariate models ranged from 0.76 to 0.80, indicating moderate to strong predictive performance (Figure 1). RVMW indices, however, showed limited prognostic value, with AUC values below 0.60 across all time points.
Conclusion
TAPSE/PASP, TAPSE/RVAD, and TAPSE/RVAS emerged as significant independent predictors of MACE in patients undergoing M-TEER, underscoring the importance of comprehensive RV assessment for risk stratification. Although RVMW indices did not demonstrate strong prognostic value in this cohort, their role in RV functional evaluation warrants further investigation in larger studies.