The following is a summary of “Refining accuracy of RV–PA coupling in patients undergoing transcatheter tricuspid valve treatment,” published in the November 2023 issue of Cardiology by Sugiura et al.

Right ventricular (RV) function assessment is a cornerstone of risk stratification in tricuspid regurgitation (TR) patients, but current techniques are limited.

Researchers conducted a retrospective study to evaluate the association between right ventricular-pulmonary artery (RV-PA) coupling and long-term outcomes after transcatheter tricuspid valve repair (TTVR).

They included patients who underwent transcatheter tricuspid valve repair for symptomatic tricuspid regurgitation (June 2015 to July 2021). An RV–PA coupling ratio was computed using a formula that divided tricuspid annular plane systolic excursion (TAPSE) by baseline echocardiographically estimated (ePASP) or invasively measured pulmonary artery systolic pressure (iPASP). The main goal was to check for deaths or heart failure readmissions within a year.

The results showed 206 high surgical risk participants (EuroSCORE II: 7.4 ± 4.8%), 57 experienced the primary outcome within 1 year. The c-statistics for the outcome were 0.565 (95% CI 0.488–0.643) for TAPSE/ePASP and 0.695 (95% CI 0.631–0.759) for TAPSE/iPASP. In patients with massive/torrential TR, the correlation between ePASP and iPASP was weakened compared to those with severe TR (interaction P=0.01). In the multivariable Cox model, TAPSE/iPASP independently reduced the risk of the primary outcome (adjusted-HR 0.67, 95% CI 0.56–0.82, P<0.001). Event-free survival at 1 year after TTVR, according to TAPSE/iPASP quartiles (i.e., ≤ 0.316; 0.317–0.407; 0.408–0.526; ≥ 0.527), was 43.4%, 48.3%, 77.9%, and 85.4%.

They concluded that RV-PA coupling predicted 1-year mortality and heart failure rehospitalization after TTVR in patients with TR, and its predictability improved with invasively measured PA pressure.

Source: link.springer.com/article/10.1007/s00392-023-02339-5