Evolution and prognostic impact of right ventricular-pulmonary artery coupling after transcatheter aortic valve replacement

Meucci, M.C.; Malara, S.; Butcher, S.C.; Hirasawa, K.; Kley, F. van der; Lombardo, A.; ... ; Graziani, F. (2023)

Article / Letter to editor

Background

There is limited evidence regarding the association between right ventricular-to-pulmonary artery (RV-PA) coupling and outcomes after transcatheter aortic valve replacement (TAVR).

Objectives

This study aimed to explore the evolution of RV-PA coupling in patients with severe aortic stenosis undergoing TAVR and its prognostic impact.

Methods

A total of 900 patients who underwent TAVR in 2 tertiary centers and with echocardiographic analysis performed within 3 months before and after the procedure were included. RV-PA coupling was measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). RV-PA uncoupling was defined by TAPSE/PASP <0.55, whereas a TAPSE/PASP <0.32 identified a severe uncoupling. The primary endpoint was all-cause mortality.

Results

A total of 520 patients (58%) showed RV-PA uncoupling before TAVR, whereas post-TAVR RV-PA uncoupling was observed in 407 patients (45%). During a median follow-up of 40 months, 250 deaths (28%) occurred. Post-TAVR RV-PA uncoupling was independently associated with an increased risk of mortality (adjusted HR: 1.474; 95% CI: 1.115-1.948; P = 0.006), whereas pre-TAVR uncoupling did not. Among patients with post-TAVR RV-PA uncoupling, the presence of severe uncoupling identified a subgroup with the worst survival (P = 0.008). Patients with RV-PA coupling recovery after TAVR showed similar outcomes as compared with patients with normal coupling. Conversely, the presence of either persistent or new-onset RV-PA uncoupling following TAVR was associated with an increased mortality risk.

Conclusions

Post-TAVR RV-PA uncoupling is an independent predictor of long-term mortality, irrespective of coupling before intervention. Assessment of TAPSE/PASP response after TAVR may be helpful to improve risk stratification.

• aortic valve stenosis
• echocardiography
• right ventricle
• RV-PA coupling
• transcatheter aortic valve replacement

• All authors: Meucci, M.C.; Malara, S.; Butcher, S.C.; Hirasawa, K.; Kley, F. van der; Lombardo, A.; Aurigemma, C.; Romagnoli, E.; Trani, C.; Massetti, M.; Burzotta, F.; Bax, J.J.; Crea, F.; Marsan, N.A.; Graziani, F.
• Date: 2023-07-10
• Journal: JACC: Cardiovascular Interventions
• Volume: 16
• Issue: 13
• Pages: 1612 - 1621
• DOI: doi:10.1016/j.jcin.2023.05.003
• Link: https://www.sciencedirect.com/science/article/pii/S1936879823008233?via%...