Prognostic Implications of a Novel Right Ventricle-Pulmonary Artery Coupling in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Replacement.

BACKGROUND

Limited evidence exists concerning the novel right ventricular (RV) to pulmonary artery (PA) coupling (RV-PA coupling) in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). We aimed to evaluate the prognostic value of this RV-PA coupling in patients after TAVR.

METHODS

Right ventricular-PA coupling was defined as the ratio of RV free wall longitudinal strain (RVFWLS) to PA systolic pressure (PASP), measured by echocardiography in AS patients undergoing TAVR between April 2012 and November 2022. The end points were all-cause death, cardiovascular rehospitalization, stroke, and a composite of these.

RESULTS

At a median follow-up time of 3.4 years, 352 (28.8%) of 1,221 patients had composite clinical events. Patients with higher RVFWLS/PASP ratio were predominantly male and had lower body mass index, more comorbidities, higher Society of Thoracic Surgeons score, more New York Heart Association IV cases, and worse laboratory data, alongside worse cardiac function compared to those with lower RVFWLS/PASP ratio. The fully adjusted multivariable hazard ratios, the RVFWLS/PASP ratio and tertile 3 of the RVFWLS/PASP ratio, were 2.228 (95% CI, 1.441-3.446) and 2.571 (95% CI, 1.633-4.047). In addition, Kaplan-Meier analyses revealed a robust graded association between the RV-PA coupling and clinical outcomes (P < .001).

CONCLUSIONS

The RV-PA coupling (RVFWLS/PASP ratio) is independently and robustly associated with adverse clinical events in patients undergoing TAVR. These data suggest that the RVFWLS/PASP ratio can serve as a risk stratification tool for patient selection and prognostication following TAVR.