Right ventricular to pulmonary arterial coupling as a predictor of survival in patients undergoing mitral valve surgery for mitral regurgitation
Omar Chehab, Edouard Long, Vitaly Androshchuk, Harminder Gill, Vassilios Avlonitis, Paolo Bosco, Gianluca Lucchese, Tiffany Patterson, Simon Redwood, Ronak RajaniAbstract
OBJECTIVES
Right ventricular-to-pulmonary artery (RV-PA) coupling has been associated with outcomes in mitral regurgitation (MR) treated by transcatheter approaches. We evaluated RV-PA coupling as a predictor of survival and post-operative length of hospital stay (LOS) in patients with mitral regurgitation undergoing mitral valve (MV) surgery.
METHODS
In this retrospective analysis (median follow-up: 5.8 years), RV-PA coupling was quantified as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) using transthoracic echocardiography (TTE). Receiver operating characteristic (ROC) curve analysis was used to determine the optimum cut-point of TAPSE/PASP to predict all-cause mortality and the study population was dichotomised according to this value. The primary end-point was all-cause mortality. A secondary end-point of LOS was also assessed.
RESULTS
Out of 142 patients (median age: 67, female: 49%), 35 showed impaired coupling at baseline (TAPSE/PASP ≤0.35). Patients with TAPSE/PASP ≤0.35 had higher absolute mortality (37% vs 8%, p < 0.001) and longer LOS (7 days vs 9 days, p = 0.04). Kaplan–Meier analysis revealed lower survival in patients with TAPSE/PASP ≤0.35 (log-rank: p < 0.0001). In multivariable Cox regression, TAPSE/PASP ≤0.35 was the most significant predictor of all-cause mortality (HR: 3.69, 95% CI: 1.31–10.1, p = 0.011), alongside chronic obstructive pulmonary disease and estimated glomerular filtration rate. TAPSE/PASP ≤0.35 was associated with significantly increased LOS (β: 4.6, 95% CI: 0.66–8.5, p = 0.022) alongside left ventricular ejection fraction, MV replacement, and urgent operation.
CONCLUSIONS
In MR patients undergoing MV surgery, TAPSE/PASP ≤0.35 is associated with increased mortality and LOS. Further validation is indicated in larger, prospective cohorts.