Is Right Ventricle-Pulmonary Artery (RV-PA) Coupling Important in Low Risk TAVR?

TAVR has long been an effective strategy to treat aortic stenosis. However, ventricular damage starts further before symptom onset, also affecting the left ventricle, pulmonary vessels, the right ventricle, the tricuspid valve, and the right atrium. 

La enfermedad vascular periférica se asocia a más eventos en el TAVI

It increases arterial afterload and uncouples the right ventricle and the pulmonary artery, defined by transthoracic echocardiogram as the relationship between the tricuspid annular plane systolic excursion (TAPSE) and  pulmonary artery systolic pressure (PASP), TAPSE/PSAP.

 A reduction in this relationship (≤0.55 mmHg) is associated with unfavorable evolution.

The study looked at PARTNER 3 patients. 222 of these patients (38.9%) presented RV-PA uncoupling TAPSE/PSAP ≤0.55 mmHg; and 348, RV-PA coupling TAPSE/PSAP >0.55 mmHg.

Primary end point was a composite of all cause death, stroke and rehospitalization at 2 years. 

Lea tambien: Should We Start Using Ultra-Thin Struts?

The populations were similar, mean age was 74, 66% were men, 30% were diabetic. Those presenting uncoupling had more arrythmia and higher BMP. 

After two years, primary end point was higher among those presenting uncoupling (19.1% vs 9.9%; HR: 2.03; 95% CI: 1.29-3.19; P=0.002), as was all cause (5.9% vs 0.6%; P < 0.001), and cardiovascular mortality (4.1% vs 0.6%; P=0.003) and rehospitalization (13.5% vs 7.3% P=0.02). Stroke rate (24.2% vs 14.2%; HR: 1.83; 95% CI: 0.98-3.41; P ¼ 0.053ke) was fairly low, with no difference.

Uncoupled patients undergoing transcatheter aortic valve replacement had a higher incidence of primary end point (24.2% vs 14.2% P=0.05).

Read also: Devices to Prepare Severely Calcified Lesions: Is There a Difference When Assessed by Intravascular Imaging?

At multivariable analysis, uncoupling resulted an independent predictor of primary end point at 2 years. 

Conclusion

In low risk symptomatic aortic stenosis patients undergoing TAVR or SAVR, baseline right ventricle and pulmonary artery uncoupling, defined as TAPSE/PSAP ≤0.55 mmHg, was associated to clinical adverse events at 2 years, including all cause and cardiovascular mortality, and rehospitalization. 

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Impact of Right Ventricle-Pulmonary Artery Coupling on Clinical Outcomes in the PARTNER 3 Trial.

Reference: Thomas J. Cahill, et al. J Am Coll Cardiol Intv 2022;15:1823–1833.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

TCT 2024 | TRISCEND II: A New Hope in Percutaneous Tricuspid Valve Replacement

Advanced tricuspid regurgitation (TR) is a debilitating disease associated with heart failure and increased mortality.  Edge-to-edge repair has been shown to improve both clinical condition...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....