Valvular & structural heart disease
Prognostic Value of Exercise Right Ventricular–Pulmonary Arterial Coupling in Primary Mitral Regurgitation
Authors' conclusion
Exercise right ventricular-pulmonary arterial coupling, particularly intermediate exTAPSE/sPAP, is a robust and feasible measure independently associated with adverse outcomes, and provides prognostic information beyond resting variables and cardiorespiratory fitness
Study context
- Population
- Moderate or severe primary mitral regurgitation, no or discordant symptoms, no LV systolic dysfunction or AF, undergoing semisupine cardiopulmonary exercise testing with exercise echocardiography
- Participants
- 211 vs 146
- Exposure
- Rest tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) and exercise TAPSE/sPAP for prognosis
- Derivationn = 211
- Validationn = 146
- Outcome
- CV death, unplanned CV hospitalisations and new AF (composite)
Methodological detailsinternational multicentre, derivation and validation cohorts
- International multicentre
- Derivation and validation cohorts
Main finding
As reported in the abstract
Primary composite end point (derivation cohort) · median follow-up 24 months (IQR 12-51)
Hazard ratio (CI)P value
Intermediate exTAPSE/sPAPper 0.1 mm/mm Hg increase; independent association
0.64(0.51–0.80)
P < 0.001Percent-predicted peak VO2 <80%independent association
2.03(1.05–3.93)
P = 0.04Per 0.1 mm/mm Hg increase, as printed
- Patients reaching composite outcome
- 48
- Lower event-free survival with reduced rest TAPSE/sPAP (cutoff 0.8 mm/mm Hg) and intermediate exercise TAPSE (exTAPSE)/sPAP (cutoff 0.6 mm/mm Hg)
- log-rank P<0.0001
Observational data: associations, not effects.
Further findings
Intermediate vs peak exTAPSE/sPAP
Feasibility
AUC Intermediate exTAPSE/sPAP 0.794 [0.730-0.849] · Peak exTAPSE/sPAP 0.765 [0.698-0.823]
- Intermediate vs peak exTAPSE/sPAP — Correlation intermediate vs peak exTAPSE/sPAP
- r=0.84; P<0.001
Validation cohort
- Consistent and robust performance of both multivariable models, continuous or categorical TAPSE/sPAP
Original publication
Prognostic Value of Exercise Right Ventricular–Pulmonary Arterial Coupling in Primary Mitral Regurgitation. Circulation. Published 3 November 2025. doi:10.
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