Impact of right ventricular-pulmonary arterial coupling on clinical outcomes in patients undergoing transcatheter aortic valve implantation.

Alwan, Louhai; Tomii, Daijiro; Heg, Dik; Okuno, Taishi; Lanz, Jonas; Praz, Fabien; Chong-Nguyen, Caroline; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Pilgrim, Thomas (2023). Impact of right ventricular-pulmonary arterial coupling on clinical outcomes in patients undergoing transcatheter aortic valve implantation. Cardiovascular revascularization medicine, 56, pp. 27-34. Elsevier 10.1016/j.carrev.2023.05.008

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AIMS

The interplay between pulmonary hypertension (PH) and right ventricular (RV) function is reflected in an index of RV function to pulmonary artery (PA) systolic pressure (PASP). The present study aimed to assess the importance of RV-PA coupling on clinical outcomes after transcatheter aortic valve implantation (TAVI).

METHODS AND RESULTS

In a prospective TAVI registry, clinical outcomes of TAVI patients with RV dysfunction or PH were stratified according to coupling or uncoupling of tricuspid annular plane systolic excursion (TAPSE) to PASP, and compared to those of patients with normal RV function and absence of PH. The median TAPSE/PASP ratio was used to differentiate uncoupling (>0.39) from coupling (<0.39). Among 404 TAVI patients, 201 patients (49.8 %) had RVD or PH at baseline: 174 patients had RV-PA uncoupling, and 27 had coupling at baseline. RV-PA hemodynamics normalized in 55.6 % of patients with RV-PA coupling and in 28.2 % of patients with RV-PA uncoupling, and deteriorated in 33.3 % of patients with RV-PA coupling and in 17.8 % of patients with no RVD, respectively, at discharge. Patients with RV-PA uncoupling after TAVI showed a trend towards an increased risk of cardiovascular death at 1 year as compared to patients with normal RV-function (HRadjusted 2.06, 95 % CI 0.97-4.37).

CONCLUSION

After TAVI, RV-PA coupling changed in a significant proportion of patients and is a potentially important metric for risk stratification of TAVI patients with RVD or PH. TWEET: "Patients with right ventricular dysfunction and pulmonary hypertension are at increased risk of death after TAVI. Integrated right ventricular to pulmonary artery hemodynamics change after TAVI in a significant proportion of patients and is instrumental to refine risk stratification."

CLINICAL TRIAL REGISTRATION

https://www.

CLINICALTRIALS

gov: NCT01368250.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Alwan, Louhai, Tomii, Daijiro, Heg, Dierik Hans, Okuno, Taishi, Lanz, Jonas, Praz, Fabien Daniel, Chong-Nguyen, Caroline Tuyet Vi, Stortecky, Stefan, Reineke, David Christian, Windecker, Stephan, Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1553-8389

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

22 May 2023 11:10

Last Modified:

18 May 2024 00:25

Publisher DOI:

10.1016/j.carrev.2023.05.008

PubMed ID:

37210220

Additional Information:

Dr. Alwan and Dr. Tomii contributed equally to this work and are joint first authors.

Uncontrolled Keywords:

Aortic stenosis Right ventricular-pulmonary arterial coupling Transcatheter aortic valve replacement

BORIS DOI:

10.48350/182713

URI:

https://boris.unibe.ch/id/eprint/182713

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