Evolution and prognostic impact of right ventricular to pulmonary artery coupling after transcatheter aortic valve implantation

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, prognostic value post-TAVI RV-PA has not been investigated so far. Purpose We aimed to explore evolution in patients with severe stenosis (AS) undergoing TAVI its impact. Methods A total 900 who underwent two tertiary centers echocardiographic analysis performed within 3 months before procedure were included. was measured as ratio tricuspid annular plane systolic excursion (TAPSE) pulmonary pressure (PASP). On basis current evidence, uncoupling defined by TAPSE/PASP<0.55, whereas a TAPSE//PAS<0.32 identified uncoupling. Primary endpoint all-cause mortality. Results 520 (58%) showed TAVI, observed 407 (45%) patients. During median follow-up 40 months, 250 (28%) deaths occurred. In multivariable Cox regression analyses adjusted for significant clinical, procedural variables, independently associated an increased risk mortality (adjusted hazard [HR]:1.450, 95% Confidence interval [CI]:1.094–1.921, p = 0.010), while pre-TAVI did not. Among uncoupling, presence subgroup worst survival HR: 1.907, 95%CI:1.160–2.815, 0.009) (Figure 1). Notably, provided better stratification mortality, than components considered separately (i.e. TAPSE PASP). Patients recovery (n=173, 33% uncoupling) similar compared normal coupling. Conversely, either persistent or new-onset following (n=347 n=67) death HR:1.422, 95%CI:1.025–1.974, 0.035 2.247, 95%CI:1.403–3.599, 0.001, respectively) 2). Conclusions Post-TAVI independent predictor long-term irrespective from intervention. Assessment TAPSE/PASP response may be helpful improve patients’ stratification.