Page 128 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Chapter six. Right ventricular - pulmonary artery coupling
did not significantly increase the chi-square value (χ2 difference = 0.02, P= 0.95, Figure 3, Panel B). However, adding TAPSE/PASP <0.35 resulted in a significant increase in the chi-square value (χ2 difference = 5.65, P=0.04, Figure 3, Panel B), demonstrating the incremental prognostic value of TAPSE/PASP.
Figure 3. Incremental prognostic value of TAPSE/PASP ratio.
The incremental value of TAPSE/PASP ratio, as a continuous value (A) and dichotomized (B), over clinical and echocardiographic parameters for the prediction of all-cause mortality.
eGFR = estimated glomerular filtration rate; LV GLS = left ventricular global longitudinal strain; PASP = pulmonary artery systolic pressure; TAPSE = tricuspid annular plane systolic excursion.
Discussion
In the present study, we evaluated the prognostic value of TAPSE/PASP (an echocardiographic surrogate of RV-PA coupling) in HF patients with significant secondary MR (Figure 4). Our findings demonstrated an independent association of TAPSE/PASP with all-cause mortality and an incremental prognostic value of the TAPSE/PASP ratio compared with use of individual parameters of RV systolic function not corrected for afterload.
Secondary MR and prognosis: role of pulmonary hypertension and right ventricular function
Secondary MR results from an imbalance between closing and tethering forces on the mitral valve due to LV dilation and dysfunction (22, 23). The chronic volume overload caused by secondary MR leads to a self-perpetuating cycle characterized by LV dilation
126