Michael I Brener1, Philipp Lurz2, Jörg Hausleiter3, Josep Rodés-Cabau4, Neil Fam5, Susheel K Kodali1, Karl-Philipp Rommel2, Guillem Muntané-Carol4, Mara Gavazzoni6, Tamim M Nazif1, Alberto Pozzoli7, Hannes Alessandrini8, Azeem Latib9, Luigi Biasco10, Daniel Braun3, Eric Brochet11, Paolo Denti12, Edith Lubos13, Sebastian Ludwig13, Daniel Kalbacher13, Rodrigo Estevez-Loureiro14, Kim A Connelly5, Christian Frerker15, Edwin C Ho9, Jean-Michel Juliard11, Claudia Harr8, Vanessa Monivas16, Georg Nickenig17, Giovanni Pedrazzini10, François Philippon4, Fabien Praz18, Rishi Puri19, Joachim Schofer8, Horst Sievert20, Gilbert H L Tang21, Martin Andreas22, Holger Thiele2, Matthias Unterhuber2, Dominique Himbert11, Marina Ureña Alcázar11, Ralph Stephan Von Bardeleben23, Stephan Windecker18, Mirjam G Wild18, Francesco Maisano12, Martin B Leon1, Maurizio Taramasso6, Rebecca T Hahn24. 1. Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA. 2. Heart Center Leipzig, University of Leipzig, Leipzig, Germany. 3. Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany. 4. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. 5. Division of Cardiology, Toronto Heart Center, St. Michael's Hospital, Toronto, Ontario, Canada. 6. Heart Center Hirslanden Zürich, Zürich, Switzerland. 7. Division of Cardiac Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland. 8. Asklepios Clinic St. Georg, Hamburg, Germany. 9. Division of Cardiology, Montefiore Medical Center, New York, New York, USA. 10. Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland. 11. Division of Cardiology, Bichat Hospital, Paris, France. 12. Division of Cardiology and Department of Cardiac Surgery, San Raffaele University Hospital, Milan Italy. 13. Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany. 14. Interventional Cardiology Clinic, University Hospital Alvaro Cunqueiro, Vigo, Spain. 15. University Heart Center, Schleswig-Holstein University, Lübeck, Germany. 16. Division of Cardiology, Puerta de Hierro University Hospital, Madrid, Spain. 17. Division of Cardiology, Bonn University Hospital, Bonn, Germany. 18. Division of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland. 19. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA. 20. Division of Cardiology, Cardiovascular Center Frankfurt, Frankfurt am Main, Germany. 21. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA. 22. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 23. Division of Cardiology, University Medical Center, Mainz, Germany. 24. Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA. Electronic address: rth2@cumc.columbia.edu.
Abstract
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.
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.
Authors: Myriam Carpenito; Valeria Cammalleri; Luka Vitez; Aurelio De Filippis; Edoardo Nobile; Maria Caterina Bono; Simona Mega; Matjaz Bunc; Francesco Grigioni; Gian Paolo Ussia Journal: J Clin Med Date: 2022-09-23 Impact factor: 4.964