Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair

Matthias Koschutnik; Carolina Donà; Christian Nitsche; Andreas A Kammerlander; Varius Dannenberg; Christina Brunner; Sophia Koschatko; Katharina Mascherbauer; Gregor Heitzinger; Kseniya Halavina; Georg Spinka; Max-Paul Winter; Martin Hülsmann; Philipp E Bartko; Christian Hengstenberg; Julia Mascherbauer; Georg Goliasch

doi:10.1007/s00392-023-02318-w

Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair

Matthias Koschutnik
, Carolina Donà
, Christian Nitsche
, Andreas A Kammerlander
, Varius Dannenberg
, Christina Brunner
, Sophia Koschatko
, Katharina Mascherbauer
, Gregor Heitzinger
, Kseniya Halavina
, Georg Spinka
, Max-Paul Winter
, Martin Hülsmann
, Philipp E Bartko
, Christian Hengstenberg
, Julia Mascherbauer
, Georg Goliasch

Division of Internal Medicine 3 (University Hospital St. Pölten)

Research output: Journal article (peer-reviewed) › Journal article

12 Citations (Scopus)

Abstract

BACKGROUND: Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.

METHODS: Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.

RESULTS: Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54%, p < 0.001).

CONCLUSIONS: TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.

Original language	English
Article number	e016031
Pages (from-to)	156-167
Number of pages	12
Journal	Clinical Research in Cardiology
Volume	114
Issue number	2
Early online date	23 Oct 2023
DOIs	https://doi.org/10.1007/s00392-023-02318-w
Publication status	Published - Feb 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Mitral regurgitation
Outcome
RV function
RV–PA coupling
TEER

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1007/s00392-023-02318-w

Cite this

Koschutnik, M., Donà, C., Nitsche, C., Kammerlander, A. A., Dannenberg, V., Brunner, C., Koschatko, S., Mascherbauer, K., Heitzinger, G., Halavina, K., Spinka, G., Winter, M.-P., Hülsmann, M., Bartko, P. E., Hengstenberg, C., Mascherbauer, J., & Goliasch, G. (2025). Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair. Clinical Research in Cardiology, 114(2), 156-167. Article e016031. https://doi.org/10.1007/s00392-023-02318-w

@article{2106abd6e97d4317bd9d1e9803c3ab3c,

title = "Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair",

abstract = "BACKGROUND: Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.METHODS: Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.RESULTS: Between April 2018 and January 2021, 156 patients (median 78 y/o, 55\% female, EuroSCORE II: 6.9\%) underwent M-TEER. On presentation, 64\% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82\%, p < 0.001), both in patients with primary (64 vs. 91\%, p = 0.009) and secondary MR (54 vs. 76\%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95\% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54\%, p < 0.001).CONCLUSIONS: TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.",

keywords = "Mitral regurgitation, Outcome, RV function, RV–PA coupling, TEER",

author = "Matthias Koschutnik and Carolina Don{\`a} and Christian Nitsche and Kammerlander, \{Andreas A\} and Varius Dannenberg and Christina Brunner and Sophia Koschatko and Katharina Mascherbauer and Gregor Heitzinger and Kseniya Halavina and Georg Spinka and Max-Paul Winter and Martin H{\"u}lsmann and Bartko, \{Philipp E\} and Christian Hengstenberg and Julia Mascherbauer and Georg Goliasch",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2025",

month = feb,

doi = "10.1007/s00392-023-02318-w",

language = "English",

volume = "114",

pages = "156--167",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "2",

}

Koschutnik, M, Donà, C, Nitsche, C, Kammerlander, AA, Dannenberg, V, Brunner, C, Koschatko, S, Mascherbauer, K, Heitzinger, G, Halavina, K, Spinka, G, Winter, M-P, Hülsmann, M, Bartko, PE, Hengstenberg, C, Mascherbauer, J & Goliasch, G 2025, 'Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair', Clinical Research in Cardiology, vol. 114, no. 2, e016031, pp. 156-167. https://doi.org/10.1007/s00392-023-02318-w

Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair. / Koschutnik, Matthias; Donà, Carolina; Nitsche, Christian et al.
In: Clinical Research in Cardiology, Vol. 114, No. 2, e016031, 02.2025, p. 156-167.

Research output: Journal article (peer-reviewed) › Journal article

TY - JOUR

T1 - Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair

AU - Koschutnik, Matthias

AU - Donà, Carolina

AU - Nitsche, Christian

AU - Kammerlander, Andreas A

AU - Dannenberg, Varius

AU - Brunner, Christina

AU - Koschatko, Sophia

AU - Mascherbauer, Katharina

AU - Heitzinger, Gregor

AU - Halavina, Kseniya

AU - Spinka, Georg

AU - Winter, Max-Paul

AU - Hülsmann, Martin

AU - Bartko, Philipp E

AU - Hengstenberg, Christian

AU - Mascherbauer, Julia

AU - Goliasch, Georg

PY - 2025/2

Y1 - 2025/2

N2 - BACKGROUND: Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.METHODS: Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.RESULTS: Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54%, p < 0.001).CONCLUSIONS: TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.

AB - BACKGROUND: Right ventricular-to-pulmonary artery (RV-PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.METHODS: Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.RESULTS: Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV-PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17-6.43, p = 0.021). At 1-year follow-up, RV-PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ - 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77-54%, p < 0.001).CONCLUSIONS: TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV-PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.

KW - Mitral regurgitation

KW - Outcome

KW - RV function

KW - RV–PA coupling

KW - TEER

UR - https://www.scopus.com/pages/publications/85174583532

U2 - 10.1007/s00392-023-02318-w

DO - 10.1007/s00392-023-02318-w

M3 - Journal article

C2 - 37870628

SN - 1861-0684

VL - 114

SP - 156

EP - 167

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

IS - 2

M1 - e016031

ER -

Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

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