TY - JOUR
T1 - Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair
AU - Brener, Michael I.
AU - Lurz, Philipp
AU - Hausleiter, Jörg
AU - Rodés-Cabau, Josep
AU - Fam, Neil
AU - Kodali, Susheel K.
AU - Rommel, Karl Philipp
AU - Muntané-Carol, Guillem
AU - Gavazzoni, Mara
AU - Nazif, Tamim M.
AU - Pozzoli, Alberto
AU - Alessandrini, Hannes
AU - Latib, Azeem
AU - Biasco, Luigi
AU - Braun, Daniel
AU - Brochet, Eric
AU - Denti, Paolo
AU - Lubos, Edith
AU - Ludwig, Sebastian
AU - Kalbacher, Daniel
AU - Estevez-Loureiro, Rodrigo
AU - Connelly, Kim A.
AU - Frerker, Christian
AU - Ho, Edwin C.
AU - Juliard, Jean Michel
AU - Harr, Claudia
AU - Monivas, Vanessa
AU - Nickenig, Georg
AU - Pedrazzini, Giovanni
AU - Philippon, François
AU - Praz, Fabien
AU - Puri, Rishi
AU - Schofer, Joachim
AU - Sievert, Horst
AU - Tang, Gilbert H.L.
AU - Andreas, Martin
AU - Thiele, Holger
AU - Unterhuber, Matthias
AU - Himbert, Dominique
AU - Alcázar, Marina Ureña
AU - Von Bardeleben, Ralph Stephan
AU - Windecker, Stephan
AU - Wild, Mirjam G.
AU - Maisano, Francesco
AU - Leon, Martin B.
AU - Taramasso, Maurizio
AU - Hahn, Rebecca T.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/2/8
Y1 - 2022/2/8
N2 - Background: The right ventricular (RV)–pulmonary arterial (PA) coupling ratio relates the efficiency with which RV stroke work is transferred into the PA. Lower ratios indicate an inadequate RV contractile response to increased afterload. Objectives: This study sought to evaluate the prognostic significance of RV-PA coupling in patients with tricuspid regurgitation (TR) who were undergoing transcatheter tricuspid valve repair or replacement (TTVR). Methods: The study investigators calculated RV-PA coupling ratios for patients enrolled in the global TriValve registry by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) from transthoracic echocardiograms performed before the procedure and 30 days after the procedure. The primary endpoint was all-cause mortality at 1-year follow-up. Results: Among 444 patients analyzed, their mean age was 76.9 ± 9.1 years, and 53.8% of the patients were female. The median TAPSE/PASP ratio was 0.406 mm/mm Hg (interquartile range: 0.308-0.567 mm/mm Hg). Sixty-three patients died within 1 year of TTVR, 21 with a TAPSE/PASP ratio >0.406 and 42 with a TAPSE/PASP ratio ≤0.406. In multivariable Cox regression analysis, a TAPSE/PASP ratio >0.406 vs ≤0.406 was associated with a decreased risk of all-cause mortality (HR: 0.57; 95% CI: 0.35-0.93; P = 0.023). In 234 (52.7%) patients with echocardiograms 30 days after TTVR, a decline in RV-PA coupling was independently associated with reduced odds of all-cause mortality (odds ratio [OR]: 0.42; 95% CI: 0.19-0.93; P = 0.032). The magnitude of TR reduction after TTVR (≥1+ vs <1+; OR: 2.53; 95% CI: 1.06-6.03; P = 0.037) was independently associated with a reduction in post-TTVR RV-PA coupling. Conclusions: RV-PA coupling is a powerful, independent predictor of all-cause mortality in patients with TR undergoing TTVR. These data suggest that the TAPSE/PASP ratio can inform patient selection and prognostication following TTVR.
AB - Background: The right ventricular (RV)–pulmonary arterial (PA) coupling ratio relates the efficiency with which RV stroke work is transferred into the PA. Lower ratios indicate an inadequate RV contractile response to increased afterload. Objectives: This study sought to evaluate the prognostic significance of RV-PA coupling in patients with tricuspid regurgitation (TR) who were undergoing transcatheter tricuspid valve repair or replacement (TTVR). Methods: The study investigators calculated RV-PA coupling ratios for patients enrolled in the global TriValve registry by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) from transthoracic echocardiograms performed before the procedure and 30 days after the procedure. The primary endpoint was all-cause mortality at 1-year follow-up. Results: Among 444 patients analyzed, their mean age was 76.9 ± 9.1 years, and 53.8% of the patients were female. The median TAPSE/PASP ratio was 0.406 mm/mm Hg (interquartile range: 0.308-0.567 mm/mm Hg). Sixty-three patients died within 1 year of TTVR, 21 with a TAPSE/PASP ratio >0.406 and 42 with a TAPSE/PASP ratio ≤0.406. In multivariable Cox regression analysis, a TAPSE/PASP ratio >0.406 vs ≤0.406 was associated with a decreased risk of all-cause mortality (HR: 0.57; 95% CI: 0.35-0.93; P = 0.023). In 234 (52.7%) patients with echocardiograms 30 days after TTVR, a decline in RV-PA coupling was independently associated with reduced odds of all-cause mortality (odds ratio [OR]: 0.42; 95% CI: 0.19-0.93; P = 0.032). The magnitude of TR reduction after TTVR (≥1+ vs <1+; OR: 2.53; 95% CI: 1.06-6.03; P = 0.037) was independently associated with a reduction in post-TTVR RV-PA coupling. Conclusions: RV-PA coupling is a powerful, independent predictor of all-cause mortality in patients with TR undergoing TTVR. These data suggest that the TAPSE/PASP ratio can inform patient selection and prognostication following TTVR.
KW - right ventricle
KW - transcatheter tricuspid valve repair
KW - transcatheter tricuspid valve replacement
KW - tricuspid regurgitation
KW - ventricular-vascular coupling
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U2 - 10.1016/j.jacc.2021.11.031
DO - 10.1016/j.jacc.2021.11.031
M3 - Article
C2 - 35115101
AN - SCOPUS:85122992882
SN - 0735-1097
VL - 79
SP - 448
EP - 461
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -