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Introduction <p>Right ventricular–pulmonary artery (RV-PA) uncoupling, expressed as the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/PAPs) ratio, is a negative prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). This study aims to investigate the association between the echocardiographically measured TAPSE/PAPs ratio and invasively determined pulmonary hypertension (PH) subtypes in this population, with the goal of identifying patients at higher risk.</p> Methods <p>This study is a retrospective analysis of 667 patients who underwent TAVR for native severe symptomatic AS at our center between January 2015 and December 2022. All patients underwent a comprehensive transthoracic echocardiographic evaluation and right heart catheterization prior to the procedure. PH was classified into: no PH, isolated post-capillary PH (IpcPH), and combined pre- and post-capillary PH (CoPH). Follow-up time was defined as the time from the procedure to the last documented contact with the patient (alive) or to the time of documented death. All-cause mortality at two years was the primary endpoint.</p> Results <p>eTAPSE/PAPs showed a moderately positive correlation with pulmonary vascular resistance (Spearman’s Rho = 0.52; <i>p</i> = 0.025) and was associated with CoPH (odds ratio 1.29, 95% confidence interval 1.10–1.30). ROC curve analysis showed that eTAPSE/PAPs discriminated presence of CoPH with an AUC of 0.740. The optimal cut-off value was 0.29&#xa0;mm/mmHg (sensitivity 72%, specificity 60%). During follow-up, 157 deaths were recorded. Kaplan-Meier curves showed a significant difference in overall mortality at 2 years when patients were stratified according to eTPASE/PAPs ratio value of 0.29 (log rank = 4.94, <i>p</i> = 0.026).</p> Conclusions <p>The eTAPSE/PAPs ratio identifies patients with symptomatic AS undergoing TAVR with higher risk of CoPH. These patients can benefit from an RHC to refine pre-operative risk assessment.</p> Graphical Abstract <p></p>

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Right ventricular-pulmonary artery uncoupling identifies higher risk of combined pulmonary hypertension in patients undergoing TAVR

  • 期刊论文

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  • 发表日期：

    2026年8月3日

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  • Francesco Putortì,
  • Tommaso Fabris,
  • Consolato Mesiani,
  • Simone Tripi,
  • Michele Strosio,
  • Marco Garaventa,
  • Antonella Capomolla,
  • Andrea Panza,
  • Giulio Sasso,
  • Samiha Tamanna,
  • Anna Pedagna,
  • Antonella Cecchetto,
  • Francesco Cardaioli,
  • Giulia Masiero,
  • Luca Nai Fovino,
  • Chiara Fraccaro,
  • Massimo Napodano,
  • Giuseppe Tarantini

摘要

Introduction

Right ventricular–pulmonary artery (RV-PA) uncoupling, expressed as the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/PAPs) ratio, is a negative prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). This study aims to investigate the association between the echocardiographically measured TAPSE/PAPs ratio and invasively determined pulmonary hypertension (PH) subtypes in this population, with the goal of identifying patients at higher risk.

Methods

This study is a retrospective analysis of 667 patients who underwent TAVR for native severe symptomatic AS at our center between January 2015 and December 2022. All patients underwent a comprehensive transthoracic echocardiographic evaluation and right heart catheterization prior to the procedure. PH was classified into: no PH, isolated post-capillary PH (IpcPH), and combined pre- and post-capillary PH (CoPH). Follow-up time was defined as the time from the procedure to the last documented contact with the patient (alive) or to the time of documented death. All-cause mortality at two years was the primary endpoint.

Results

eTAPSE/PAPs showed a moderately positive correlation with pulmonary vascular resistance (Spearman’s Rho = 0.52; p = 0.025) and was associated with CoPH (odds ratio 1.29, 95% confidence interval 1.10–1.30). ROC curve analysis showed that eTAPSE/PAPs discriminated presence of CoPH with an AUC of 0.740. The optimal cut-off value was 0.29 mm/mmHg (sensitivity 72%, specificity 60%). During follow-up, 157 deaths were recorded. Kaplan-Meier curves showed a significant difference in overall mortality at 2 years when patients were stratified according to eTPASE/PAPs ratio value of 0.29 (log rank = 4.94, p = 0.026).

Conclusions

The eTAPSE/PAPs ratio identifies patients with symptomatic AS undergoing TAVR with higher risk of CoPH. These patients can benefit from an RHC to refine pre-operative risk assessment.

Graphical Abstract