Evaluating the Prognostic Significance of Right Ventricular‐Pulmonary Artery Coupling Prior to Transcatheter Aortic Valve Replacement

ABSTRACT Purpose This study aims to assess the prognostic significance of right ventricular (RV) function, evaluated through pre‐procedural RV‐free wall longitudinal strain and RV‐pulmonary artery (PA) coupling, in predicting all‐cause mortality in patients with severe aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR). Methods We conducted a retrospective cohort study involving patients with severe AS who underwent TAVR at a Latin American referral centre between 2016 and 2022. Pre‐procedural RV function was assessed using conventional parameters and RV‐free wall longitudinal strain. RV‐PA coupling was evaluated using the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio and the RV‐free wall longitudinal strain/PASP ratio (RVFWLS/PASP). The primary outcome was all‐cause mortality up to 3.5 years. Results A total of 67 patients (mean age 79 ± 9 years, 42% female) who underwent TAVR were included in the study. Ten patients (15%) died during the follow‐up period. The most commonly implanted prosthesis was the Edwards Sapien 3 (38%). Most patients had preserved left ventricular ejection fraction (80%). The deceased group had higher pulmonary artery systolic pressure (PASP) and lower RV‐arterial coupling, though conventional RV function parameters did not show significant differences. Cox proportional hazards regression analysis identified the TAPSE/PASP ratio (HR 5.37 [95% CI 1.53–18.80], p = 0.009) and RVFWLS/PASP ratio (HR 2.45 [95% CI 1.46–91.62], p = 0.020) as predictors of all‐cause mortality. Conclusions In patients with severe AS undergoing TAVR, pre‐procedural RV‐PA coupling, as assessed by the TAPSE/PASP ratio (< 0.36 mm/mmHg) and RVFWLS/PASP ratio (< 0.74%/mmHg), strongly predicts an increased risk of all‐cause mortality at 3.5 years post‐procedure.