Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 2;10(5):1006.
doi: 10.3390/jcm10051006.

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

Blanca Trejo-Velasco  1 , Rodrigo Estevez-Loureiro  2 , Fernando Carrasco-Chinchilla  3   4 , Felipe Fernández-Vázquez  5 , Dabit Arzamendi  6 , Manuel Pan  7 , Isaac Pascual  8 , Luis Nombela-Franco  9 , Ignacio J Amat-Santos  4   10 , Xavier Freixa  11 , Rosa Ana Hernández-Antolín  12 , Ramiro Trillo-Nouche  4   13 , Leire Andraka Ikazuriaga  14 , José R López-Mínguez  15 , Dario Sanmiguel Cervera  16 , Juan Sanchis  4   17 , José Luis Diez-Gil  18 , Valeriano Ruiz-Quevedo  19 , Cristóbal Urbano-Carrillo  20 , Víctor Manuel Becerra-Muñoz  3   4 , Tomás Benito-González  5 , Chi Hion Li  6 , Dolores Mesa  7 , Pablo Avanzas  8 , Germán Armijo  9 , Ana María Serrador-Frutos  10 , Laura Sanchis  11 , Covadonga Fernández-Golfín Lobán  12 , Belén Cid-Álvarez  4   13 , José María Hernández-García  3   4 , Carmen Garrote-Coloma  5 , Estefanía Fernández-Peregrina  6 , Miguel Romero  7 , Víctor León Arguero  8 , Ignacio Cruz-González  1   4   21
Affiliations

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

Blanca Trejo-Velasco et al. J Clin Med. .

Abstract

Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA).

Methods: Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality.

Results: Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, p = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately.

Conclusions: TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.

Keywords: MitraClip; mitral valve regurgitation; mitral valve repair; pulmonary hypertension; right ventricular to pulmonary arterial coupling; transthoracic echocardiography.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Survival analysis according to TAPSE/PASP ratio as shown by Kaplan–Meier curves. TAPSE/PASP ratio ≤ 0.35 is associated with higher rates of the primary combined endpoint (a), higher HF readmissions rates (b) without differences in all-cause mortality rates (c). TAPSE: tricuspid annular plane systolic excursion. PASP: pulmonary artery systolic pressure.
Figure 2
Figure 2
Survival analysis according to TAPSE/PASP ratio as shown by Kaplan–Meier curves, stratified according to MR aetiology. TAPSE/PASP ratio ≤ 0.35 is associated with higher rates of the primary combined endpoint in patients with primary MR (a), secondary MR (b) and mixed MR (c).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Feldman T., Foster E., Glower D.D., Kar S., Rinaldi M.J., Fail P.S., Smalling R.W., Siegel R., Rose G.A., Engeron E., et al. EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation. N. Engl. J. Med. 2011;364:1395–1406. doi: 10.1056/NEJMoa1009355. - DOI - PubMed
    1. Sorajja P., Vemulapalli S., Feldman T., Mack M., Holmes D.R., Jr., Stebbins A., Kar S., Thourani V., Ailawadi G. Outcomes with Transcatheter Mitral Valve Repair in the United States: An STS/ACC TVT Registry Report. J. Am. Coll. Cardiol. 2017;70:2315–2327. doi: 10.1016/j.jacc.2017.09.015. - DOI - PubMed
    1. Ailawadi G., Lim D.S., Mack M.J., Trento A., Kar S., Grayburn P.A., Glower D.D., Wang A., Foster E., Qasim A., et al. EVEREST II Investigators. One-Year Outcomes after MitraClip for Functional Mitral Regurgitation. Circulation. 2019;139:37–47. doi: 10.1161/CIRCULATIONAHA.117.031733. - DOI - PubMed
    1. Maisano F., Franzen O., Baldus S., Schäfer U., Hausleiter J., Butter C., Ussia G.P., Sievert H., Richardt G., Widder J.D., et al. Percutaneous mitral valve interventions in the real world: Early and 1-year results from the ACCESS-EU, a prospective, multicenter, nonrandomized post-approval study of the MitraClip therapy in Europe. J. Am. Coll. Cardiol. 2013;62:1052–1061. doi: 10.1016/j.jacc.2013.02.094. - DOI - PubMed
    1. Baumgartner H., Falk V., Bax J.J., De Bonis M., Hamm C., Holm P.J., Iung B., Lancellotti P., Lansac E., Rodriguez Muñoz D., et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2017;38:2739–2791. doi: 10.1093/eurheartj/ehx391. - DOI - PubMed