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Valvular heart disease
Original research article
Right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation
  1. Ibrahim Sultan1,2,
  2. Arturo Cardounel1,2,
  3. Islam Abdelkarim2,
  4. Arman Kilic1,2,
  5. Andrew D Althouse2,
  6. Michael S Sharbaugh2,
  7. Aman Gupta3,
  8. Jeff Xu3,
  9. Miho Fukui2,4,
  10. Marc A Simon2,4,
  11. John T Schindler2,4,
  12. Joon S Lee2,4,
  13. Thomas G Gleason1,2,
  14. João L Cavalcante2,4
  1. 1 Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2 Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3 Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4 Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr João L Cavalcante, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA; joaocavalcantemd{at}gmail.com

Abstract

Objectives To evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI).

Background RV function and pulmonary hypertension (PH) are both prognostically important in patients receiving TAVI. RV-PA coupling has been shown to be prognostic important in patients with heart failure but not previously evaluated in TAVI patients.

Methods Consecutive patients with severe aortic stenosis who received TAVI from July 2011 through January 2016 and with comprehensive baseline echocardiogram were included. All individual echocardiographic images and Doppler data were independently reviewed and blinded to the clinical information and outcomes. Cox models quantified the effect of TAPSE/PASP quartiles on subsequent all-cause mortality while adjusting for confounders.

Results A total of 457 patients were included with mean age of 82.8±7.2 years, left ventricular ejection fraction (LVEF) 54%±13%, PASP 44±17 mm Hg. TAPSE/PASP quartiles showed a dose-response relationship with survival. This remained significant (HR for lowest quartile vs highest quartile=2.21, 95% CI 1.07 to 4.57, p=0.03) after adjusting for age, atrial fibrillation, LVEF, stroke volume index, Society of Thoracic Surgeons Predicted Risk of Mortality.

Conclusion Baseline TAPSE/PASP ratio is associated with all-cause mortality in TAVI patients as it evaluates RV systolic performance at a given degree of afterload. Incorporation of right-side unit into the risk stratification may improve optimal selection of patients for TAVI.

  • transcatheter valve interventions
  • secondary pulmonary hypertension
  • aortic stenosis

https://doi.org/10.1136/heartjnl-2018-313385

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    Footnotes

    • Contributors All coauthors have contributed to the manuscript preparation, read, and approve it. João L Cavalcante is wholly responsible for the content. All the co-authors have signed off on this and agree with her inclusion.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer JLC and TGG received investigator-initiated grant support from Medtronic Inc.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University of Pittsburgh Institutional Review Board Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.