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

• Published in: JACC. Cardiovascular interventions Vol. 16; no. 13; pp. 1612 - 1621
• Main Authors: Meucci, Maria Chiara, Malara, Silvia, Butcher, Steele C., Hirasawa, Kensuke, van der Kley, Frank, Lombardo, Antonella, Aurigemma, Cristina, Romagnoli, Enrico, Trani, Carlo, Massetti, Massimo, Burzotta, Francesco, Bax, Jeroen J., Crea, Filippo, Ajmone Marsan, Nina, Graziani, Francesca
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 10-07-2023
• Subjects: aortic valve stenosis; Echocardiography; Humans; Prognosis; Pulmonary Artery - diagnostic imaging; right ventricle; RV-PA coupling; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; RV-PA coupling; RV; AF; echocardiography; aortic valve stenosis; LVEF; LV; LAVi; PASP; TAPSE; TAVR; RV-PA; AS; right ventricle; transcatheter aortic valve replacement; TR
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2023.05.003

There is limited evidence regarding the association between right ventricular-to-pulmonary artery (RV-PA) coupling and outcomes after transcatheter aortic valve replacement (TAVR).
This study aimed to explore the evolution of RV-PA coupling in patients with severe aortic stenosis undergoing TAVR and its prognostic impact.
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.
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.
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.
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