Phenotypes, periprocedural hemodynamic changes, and impact of pulmonary hypertension in patients undergoing mitral transcatheter edge-to-edge repair.

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.