Pulmonary Artery Pulsatility Index and Clinical Outcomes in Patients Undergoing Transcatheter Tricuspid Valve Replacement.

BACKGROUND

Right ventricular (RV) function is a key determinant of outcomes after transcatheter tricuspid interventions. The pulmonary artery pulsatility index (PAPI), an invasive hemodynamic index reflecting RV interaction with filling pressures and pulmonary circulation, has prognostic value in several cardiovascular conditions. However, its role in transcatheter tricuspid valve replacement (TTVR) remains unknown.

OBJECTIVES

The aim of this study was to investigate the prognostic implications of PAPI in patients undergoing TTVR.

METHODS

Patients with severe tricuspid regurgitation undergoing orthotopic TTVR with available preprocedural right heart catheterization data were retrospectively analyzed. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization at 2-year follow-up. Patients were stratified according to an optimal PAPI cutoff derived from maximally selected rank statistics on the basis of the log-rank test.

RESULTS

Among 94 patients (median age 78 years [Q1-Q3: 72-82 years], 59% women), 28 (30%) had low PAPI (≤1.13). The median duration of follow-up was 491 days (Q1-Q3: 227-879 days). Kaplan-Meier estimates of survival free from the composite endpoint, all-cause mortality, and heart failure hospitalization were 29.2% (95% CI: 13.6%-62.5%), 52.6% (95% CI: 30.2%-91.7%), and 49.1% (95% CI: 28.4%-85.1%) in the low PAPI group vs 70.0% (95% CI: 58.6%-83.5%), 87.6% (95% CI: 79.2%-96.9%), and 76.6% (95% CI: 65.4%-89.6%) in the high PAPI group (log-rank P < 0.001, log-rank P = 0.006, and log-rank P = 0.017, respectively). On multivariable Cox regression analysis with Firth's penalized likelihood, PAPI ≤1.13 was independently associated with the primary endpoint (HR: 2.50; 95% CI: 1.18-5.27; P = 0.018), irrespective of RV longitudinal function and age.

CONCLUSIONS

In patients undergoing TTVR, low preprocedural PAPI identifies a high-risk phenotype, and it is independently associated with adverse outcomes. PAPI may represent a simple and valuable tool for risk stratification in TTVR patients.