Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients

Abstract

AimsTo investigate the impact of the right ventricle to pulmonary artery (RV-PA) coupling on the outcome of patients undergoing transcatheter aortic valve intervention (TAVI), and to describe changes in right ventricular function, pulmonary hypertension, and their ratio after TAVI.MethodsThree hundred and seventy-seven patients from the Italian ClinicalService Project, who underwent TAVI between February 2011 and August 2020, were included. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was retrospectively calculated as a surrogate of RV-PA coupling. The population was stratified according to TAPSE/PASP using a cut-off of 0.36 mm/mmHg derived from a receiving operating characteristic (ROC) curve. The primary end point was 6-month all-cause death.ResultsCompared with patients with a TAPSE/PASP ratio ≥0.36 mm/mmHg (81%), those with TAPSE/PASP ratio <0.36 mm/mmHg (19%) had more comorbidities and were more symptomatic.Moreover, they were more likely to receive general anesthesia and an old generation device. Device success was similar between the two groups. A TAPSE/PASP ratio <0.36 mm/mmHg was associated with a higher risk of all-cause death at 6-months (17.3% versus 5.3%; adjusted HR 2.66; P = 0.041). The prognostic impact of the TAPSE/PASP ratio was stronger than the impact of TAPSE and PASP as separate parameters and was independent of the surgical risk score. Both TAPSE, PASP, and their ratio improved from baseline to 1 month and 6 months after TAVI.ConclusionsA TAPSE/PASP ratio <0.36 mm/mmHg is strongly associated with an increased risk of mortality after TAVI. Providing a left ventricle unloading, TAVI is associated with improvement of both TAPSE, PASP, and their ratio.

Prognostic role of tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio in patients hospitalized for acute heart failure

“…In our study, the univariable and multivariable analysis for both TAPSE and PASP alone in AHF showed a weaker prognostic impact. TAPSE/PASP, as a surrogate of RV longitudinal shortening to developed pressure, is a strong prognostic parameter in several groups of patients, 14,21,[31][32][33][34][35][36][37] including AHF in preserved EF23. TAPSE/PASP of less than 0.36 mm/mmHg was an independent predictor of heart failure-related recurrent admissions [incidence rate ratio (IRR) 1.51, 95% CI 1.01-2.24; P ¼ 0.040], while patients with TAPSE/PASP less than 0.28 mm/mmHg had the highest risk for both allcause and heart failure-related recurrent admissions (IRR 1.40, 95% CI 1.04-1.87, P ¼ 0.025; and IRR 1.85, 95% CI 1.22-2.80, P ¼ 0.004, respectively).…”

Cardiovascular imaging updates and future perspectives

“…A TAPSE/PASP (pulmonary artery systolic pressure) ratio less than 0.36 mm/mmHg is strongly associated with an increased risk of mortality after transcatheter aortic valve implantation (TAVI). Providing LV unloading, TAVI is associated with the improvement of both TAPSE, PASP and their ratio 24 …”

“…Providing LV unloading, TAVI is associated with the improvement of both TAPSE, PASP and their ratio. 24 Although the diagnosis of aortic stenosis is mostly based on echocardiographic assessment, computer tomography (CT) is essential for the proper planning of TAVI. An ECGgated cardiac CT provides 3D images of the heart, allowing a complete evaluation of valvular morphology, in particular of aortic annulus, ascending aorta, coronary arteries and peripheral access.…”

Ventriculo-arterial uncoupling in acute heart failure: right heart is the matter

“…Although the primary application has been made in the context of PAH, the logical assumption is that the TAPSE/PASP ratio may represent a marker of RV-to-pulmonary arterial coupling/uncoupling in any case of increased RV afterload regardless of the cause, and this has led several researchers to apply it in other clinical settings 16 . Unsurprisingly, it has been shown to accurately predict prognosis in chronic HF, independently of the phenotype 14,17 …”

“…Although the primary application has been made in the context of PAH, the logical assumption is that the TAPSE/PASP ratio may represent a marker of RV-topulmonary arterial coupling/uncoupling in any case of increased RV afterload regardless of the cause, and this has led several researchers to apply it in other clinical settings. 16 Unsurprisingly, it has been shown to accurately predict prognosis in chronic HF, independently of the phenotype. 14,17 However, the clinical and prognostic role of TAPSE/PASP in hospitalized AHF, where volume overload and congestion are suggestive of a deterioration of the RV-to-pulmonary arterial coupling, is not well established and results from former studies are controversial.…”