ArticleCardiovascular intervention and therapeutics2026
Phenotypes, periprocedural hemodynamic changes, and impact of pulmonary hypertension in patients undergoing mitral transcatheter edge-to-edge repair.
Article in Cardiovascular intervention and therapeutics, 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
Hemodynamic pulmonary hypertension (PH) phenotypes after mitral transcatheter edge-to-edge repair (M-TEER) and their prognostic implications remain unclear. We analyzed 184 patients with mitral regurgitation (MR) undergoing M-TEER (2018-2025) with paired invasive pre- and post-procedural right-heart catheterization. PH phenotypes were classified per 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines. The primary endpoint was all-cause death or heart failure (HF) rehospitalization, assessed using Kaplan-Meier analysis and Cox regression. Median age was 81.0 years, 57.6% were male, and median EuroSCORE II was 3.3%. Baseline PH was present in 93 patients (50.5%). After M-TEER, 99 (53.8%) had no PH, 30 (16.3%) pre-capillary PH, 12 (6.5%) isolated post-capillary PH, and 43 (23.4%) combined pre- and post-capillary PH (CpcPH). Compared with no PH after M-TEER, residual PH was associated with a higher risk of the primary endpoint (aHR 3.43, 95%CI 1.55-7.56, P = 0.002). In exploratory multivariable analyses, residual pre-capillary PH (aHR 3.83, 95%CI 1.40-10.52, P = 0.009) and CpcPH (aHR 3.60, 95%CI 1.47-8.82, P = 0.005), but not isolated post-capillary PH (aHR 2.07, 95%CI 0.40-10.65, P = 0.385), showed stronger associations with the primary endpoint. No significant interaction was detected between residual PH and MR etiology (all P-interaction > 0.05). Residual PH was observed in approximately half of patients undergoing M-TEER and was associated with an increased risk of clinical outcomes. In particular, pre-capillary PH and CpcPH showed a stronger association with clinical outcomes than isolated post-capillary PH.
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