The following is a summary of “Novel Right Ventricular Function Parameters Can Identify Short-Term Non-Responders To Transcatheter Edge-To-Edge Repair For Mitral Regurgitation,” published in the March 2025 issue of American Journal of Cardiology by Mistrulli et al. 

Mitral regurgitation (MR) is a prevalent valvular heart condition often associated with poor clinical outcomes, especially when left untreated or inadequately managed. While percutaneous mitral valve repair (PMVR) with the MitraClip system, in conjunction with guideline-directed medical therapy, has demonstrated clinical and prognostic benefits in select patients with symptomatic severe MR, a considerable proportion of individuals continue to experience major adverse cardiovascular events (MACE)—including death or heart failure-related hospitalizations, within the first year following the procedure. Consequently, early identification of patients who are unlikely to respond favorably remains a critical clinical goal. This study aimed to evaluate the prognostic significance of advanced echocardiographic measures of right ventricular function in predicting short-term adverse outcomes following PMVR. A cohort of 60 consecutive patients undergoing PMVR for symptomatic severe MR was prospectively analyzed. 

Comprehensive transthoracic echocardiographic evaluations were conducted at baseline, immediately post-procedure before discharge, and at six months of follow-up. Key parameters included tricuspid annular plane systolic excursion (TAPSE) indexed to pulmonary artery systolic pressure (PASP), right ventricular end-diastolic area (RVAD), and end-systolic area (RVAS), resulting in three composite indices: TAPSE/PASP, TAPSE/RVAD, and TAPSE/RVAS. Additionally, RV myocardial work indices were examined. Within one year of PMVR, 35% of patients developed MACE. Baseline comparisons revealed that those with subsequent MACE had significantly elevated serum creatinine, troponin T, and NT-proBNP levels, in addition to increased RV chamber dimensions and reduced TAPSE values (all p < 0.05), while other clinical, imaging, and procedural variables did not differ notably between groups. Multivariate regression identified TAPSE/PASP, TAPSE/RVAD, and TAPSE/RVAS as independent predictors of MACE, each demonstrating strong discriminatory performance with the area under the receiver operating characteristic curves (AUCs) ranging from 0.80 to 0.85. 

These TAPSE-derived indices remained consistently lower throughout follow-up in patients who experienced adverse events, reinforcing their prognostic utility. Conversely, RV myocardial work indices displayed relatively poor predictive value, with AUCs falling below 0.60. The findings emphasize that an integrative echocardiographic assessment of RV function, particularly using TAPSE in combination with RV size and pressure estimates, offers valuable prognostic insight into short-term outcomes following PMVR. Identifying patients at elevated risk of poor clinical progression through these noninvasive markers may allow for improved postoperative monitoring, targeted management, and potential optimization of therapeutic strategies. In contrast, the limited predictive strength of RV myocardial work metrics suggests their reduced applicability in this context. Overall, this study supports the routine incorporation of RV functional indices, specifically TAPSE-based ratios, into the post-PMVR risk stratification framework.

Source: ajconline.org/article/S0002-9149(25)00210-3/abstract