ArticleEuropean heart journal. Imaging methods and practice2026
Prognostic impact of right ventricular to pulmonary arterial coupling for patients undergoing surgery for severe mitral regurgitation.
Article in European heart journal. Imaging methods and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Cardiac surgery may induce abrupt changes in pre-load, afterload, and right ventricular contractility. The ability of the right ventricle to maintain systolic performance in the presence of increased afterload is referred to as right ventricular-pulmonary artery (RV-PA) coupling. To assess RV-PA coupling in patients undergoing surgery for severe mitral regurgitation (MR), to identify a tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) threshold for RV-PA uncoupling, and to evaluate its prognostic value for early mortality, right heart failure (RHF), post-operative course, and late mortality. Methods and results: This retrospective single-centre observational study included 277 patients who underwent surgery for severe MR between January 2018 and March 2023. RV-PA coupling was assessed using the ratio of TAPSE/PASP derived from pre-operative transthoracic echocardiography. The primary endpoint was early all-cause mortality within 30 days. Secondary endpoints included mortality from RHF, length of intensive care unit (ICU) stay, length of hospital stay, and late all-cause mortality.Receiver operating characteristic analysis identified an optimal TAPSE/PASP cut-off of 0.30 mm/mmHg to define RV-PA uncoupling. Patients with TAPSE/PASP ≤0.30 mm/mmHg had significantly higher early mortality and worse post-operative outcomes. In multivariable logistic regression, TAPSE/PASP remained an independent predictor of early mortality together with EuroSCORE II, cardiopulmonary bypass time, and weaning from bypass requiring ECMO or inotropic support. In a sensitivity analysis restricted to isolated mitral valve (MV) surgery, TAPSE/PASP remained the only independent predictor of early mortality. RV-PA uncoupling was also associated with excess early mortality from RHF and longer ICU and hospital stay, but not with late mortality. Conclusion: Pre-operative RV-PA uncoupling assessed by TAPSE/PASP is strongly associated with early mortality and post-operative RHF after MV surgery for severe MR and may help refine perioperative risk stratification.
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