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• W4381114252 abstract "Abstract Funding Acknowledgements Type of funding sources: None. Background there is limited evidence regarding the association between right ventricular-to-pulmonary artery (RV-PA) coupling and outcomes after transcatheter aortic valve implantation (TAVI). Particularly, the prognostic value of post-TAVI RV-PA coupling has not been investigated so far. Purpose We aimed to explore the evolution of RV-PA coupling in patients with severe aortic stenosis (AS) undergoing TAVI and its prognostic impact. Methods A total of 900 patients who underwent TAVI in two tertiary centers and with echocardiographic analysis performed within 3 months before and after the procedure were included. RV-PA coupling was measured as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). On the basis of current evidence, RV-PA uncoupling was defined by TAPSE/PASP&lt;0.55, whereas a TAPSE//PAS&lt;0.32 identified a severe uncoupling. Primary endpoint was all-cause mortality. Results A total of 520 (58%) patients showed RV-PA uncoupling before TAVI, whereas post-TAVI RV-PA uncoupling was observed in 407 (45%) patients. During a median follow-up of 40 months, 250 (28%) deaths occurred. In multivariable Cox regression analyses adjusted for significant clinical, procedural and echocardiographic variables, post-TAVI RV-PA uncoupling was independently associated with an increased risk of mortality (adjusted hazard ratio [HR]:1.450, 95% Confidence interval [CI]:1.094–1.921, p = 0.010), while pre-TAVI uncoupling did not. Among patients with post-TAVI RV-PA uncoupling, the presence of severe uncoupling identified a subgroup with the worst survival (adjusted HR: 1.907, 95%CI:1.160–2.815, p = 0.009) (Figure 1). Notably, post-TAVI RV-PA uncoupling provided better risk stratification for all-cause mortality, than its components considered separately (i.e. TAPSE and PASP). Patients with RV-PA coupling recovery after TAVI (n=173, 33% of patients with pre-TAVI uncoupling) showed similar outcomes as compared to patients with normal coupling. Conversely, the presence of either persistent or new-onset RV-PA uncoupling following TAVI (n=347 and n=67) was associated with an increased risk of death (adjusted HR:1.422, 95%CI:1.025–1.974, p = 0.035 and adjusted HR: 2.247, 95%CI:1.403–3.599, p = 0.001, respectively) (Figure 2). Conclusions Post-TAVI RV-PA uncoupling is an independent predictor of long-term mortality, irrespective from coupling before intervention. Assessment of TAPSE/PASP response after TAVI may be helpful to improve patients’ risk stratification." @default.
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• W4381114252 date "2023-06-01" @default.
• W4381114252 modified "2023-10-02" @default.
• W4381114252 title "Evolution and prognostic impact of right ventricular to pulmonary artery coupling after transcatheter aortic valve implantation" @default.
• W4381114252 doi "https://doi.org/10.1093/ehjci/jead119.310" @default.
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