Valvular & structural heart diseaseCohort study
Evolution and Prognostic Impact of Right Ventricular–Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement
- Retrospective cohort study
- 2 tertiary centres
Authors' conclusion
Post-TAVR RV-PA uncoupling is an independent predictor of long-term mortality, irrespective of coupling before intervention.
Study context
- Population
- Patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) with echocardiography within 3 months before and after the procedure
- Participants
- 900 patients
- Exposure
- Post-TAVR right ventricular-to-pulmonary artery (RV-PA) uncoupling vs no uncoupling
- Post-TAVR RV-PA uncouplingn = 407
- Outcome
- All-cause mortality
- Follow-up
- Median 40 months
Main finding
As reported in the abstract
Adjusted hazard ratio
1.474
95% CI 1.115–1.948
P = 0.006
Post-TAVR RV-PA uncoupling vs No post-TAVR uncoupling
adjusted HR 1.474 (95% CI 1.115–1.948); P = 0.006
- Deaths during follow-up
- 250 (28%)
Observational data: associations, not effects.
Further findings
Prevalence of RV-PA uncoupling
- Pre-TAVR uncoupling
- 520 (58%)
- Post-TAVR uncoupling
- 407 (45%)
Survival by severe uncoupling (tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) <0.32), among post-TAVR uncoupling
- Severe uncoupling identified the subgroup with worst survival
- P = 0.008
Mortality by coupling trajectory
- Coupling recovery after TAVR: outcomes similar to normal coupling
- Persistent or new-onset uncoupling: increased mortality risk
Original publication
Evolution and Prognostic Impact of Right Ventricular–Pulmonary Artery Coupling After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. Published 10 July 2023. doi:10.1016/j.jcin.2023.05.003
Summarised from the published abstract; every number is checked against it