Right ventriculo-arterial coupling and association with outcomes in patients undergoing transcatheter mitral valve replacement - 08/01/26
, G. Suc 1, J. Farjat-Pasos 2, C. Delhomme 3, A. Cailliau 3, K. Mihoubi 4, J. Mesnier 1, G. Ducrocq 1, B. Iung 3, E. Brochet 5, S. Mohammadi 6, J. Rodés-Cabau 2, M. Urena Alcazar 3Résumé |
Introduction |
Transcatheter mitral valve replacement (TMVR) offers an effective treatment option for high-risk surgical candidates with mitral valve disease. However, its broader adoption is hindered by anatomical challenges and complexities in patient selection. Right ventriculo-arterial coupling (RVAC) has emerged as a promising echocardiographic prognostic marker in valvular heart disease but remains understudied in the TMVR population.
Objective |
To evaluate right ventricular (RV) dysfunction based on RVAC status in patients undergoing TMVR and to assess its association with clinical outcomes.
Method |
We conducted a retrospective analysis of patients who underwent valve-in-valve TMVR at two centers-one in France and one in Canada-between March 2011 and January 2023. Comprehensive echocardiographic assessments were performed before and after the procedure. RV function and RVAC, defined as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), were evaluated for their prognostic significance in predicting 2-year outcomes. The primary endpoint was a composite of cardiovascular death and hospitalization for heart failure.
Results |
A total of 151 patients underwent TMVR. The median age was 74 years, and 64% were female. Patients were stratified into two groups: impaired RVAC (I-RVAC, TAPSE/PASP < 0.24 mm/mmHg, n = 54) and preserved RVAC (P-RVAC, TAPSE/PASP ≥0.24 mm/mmHg, n = 97). Two-year event-free survival was significantly lower in the I-RVAC group (38 vs. 70%, P < 0.01) ( Fig. 1 ). In multivariable analysis, impaired RVAC was an independent predictor of the primary composite outcome (HR 2.61, p < 0.01). Among I-RVAC patients, 76% showed post-procedural RVAC improvement, which was associated with improved event-free survival.
Conclusion |
RVAC, as assessed by the TAPSE/PASP ratio, is a strong prognostic marker in patients undergoing TMVR. Its evaluation may enhance risk stratification and inform clinical decision-making. Further studies are warranted to validate these findings and refine patient selection strategies for TMVR.
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Vol 119 - N° 1S
P. S75 - janvier 2026 Retour au numéro
Article précédent
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