Evolution and Prognostic Impact of Right Ventricular-Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement

Maria Chiara Meucci; Silvia Malara; Steele C Butcher; Kensuke Hirasawa; Frank van der Kley; Antonella Lombardo; Cristina Aurigemma; Enrico Romagnoli; Carlo Trani; Massimo Massetti; Francesco Burzotta; Jeroen J Bax; Filippo Crea; Nina Ajmone Marsan; Francesca Graziani

doi:10.1016/j.jcin.2023.05.003

Evolution and Prognostic Impact of Right Ventricular-Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement

JACC Cardiovasc Interv. 2023 Jul 10;16(13):1612-1621. doi: 10.1016/j.jcin.2023.05.003.

Authors

Affiliations

¹ Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
² Catholic University of the Sacred Heart, Rome, Italy.
³ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Australia.
⁴ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
⁵ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
⁶ Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy.
⁷ Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁸ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
⁹ Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: francesca.graziani@policlinicogemelli.it.

PMID: 37438027
DOI: 10.1016/j.jcin.2023.05.003

Abstract

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.

Keywords: RV-PA coupling; aortic valve stenosis; echocardiography; right ventricle; transcatheter aortic valve replacement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Echocardiography
Humans
Prognosis
Pulmonary Artery* / diagnostic imaging
Transcatheter Aortic Valve Replacement* / adverse effects
Treatment Outcome