Right Ventricular-Pulmonary Artery Coupling in Tricuspid Regurgitation: Prognostic Value and Impact of Treatment Strategy
- PMID: 40500010
- DOI: 10.1016/j.jcin.2025.04.033
Right Ventricular-Pulmonary Artery Coupling in Tricuspid Regurgitation: Prognostic Value and Impact of Treatment Strategy
Abstract
Background: Right ventricular-pulmonary artery coupling (RVPAC) predicts outcomes after transcatheter tricuspid valve edge-to-edge repair (T-TEER), but its role in patient selection remains unclear.
Objectives: The aim of this study was to evaluate the prognostic implications of RVPAC in a European registry of patients with tricuspid regurgitation undergoing either T-TEER or medical management.
Methods: Among 1,885 patients with tricuspid regurgitation (n = 585 medical, n = 1,300 T-TEER), 946 were propensity matched (1:1). RVPAC, assessed as the ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure was analyzed for its association with 1-year mortality.
Results: RVPAC was significantly associated with mortality (HR: 0.11; 95% CI: 0.04-0.29; P < 0.01), with an optimized cutoff of 0.41 mm/mm Hg. Mortality differed significantly by RVPAC in both treatment groups (log-rank P < 0.01). Across RVPAC tertiles (<0.32, 0.32-0.46, and >0.46 mm/mm Hg), tricuspid annular plane systolic excursion increased (14 mm [Q1-Q3: 12-17 mm] vs 18 mm [Q1-Q3: 15-20 mm] vs 21 mm [Q1-Q3: 18-24 mm]; P < 0.01), while systolic pulmonary artery pressure (60 mm Hg [Q1-Q3: 50-70 mm Hg] vs 45 mm Hg [Q1-Q3: 40-52 mm Hg] vs 34 mm Hg [Q1-Q3: 29-41 mm Hg]; P = 0.30) and kidney function (43 mL/min/m2 [Q1-Q3: 30-57 mL/min/m2] vs 49 mL/min/m2 [Q1-Q3: 38-67 mL/min/m2] vs 53 mL/min/m2 [Q1-Q3: 40-69 mL/min/m2]; P = 0.03) declined. Mortality was highest in the low RVPAC tertile, with no difference between treatment modalities (HR: 1.04; 95% CI: 0.68-1.61; P = 0.85). T-TEER was associated with better survival than medical management in the intermediate RVPAC tertile (HR: 0.54; 95% CI: 0.31-0.94; P = 0.03). This difference persisted but weakened in the high RVPAC tertile, with the overall most favorable outcomes (HR: 0.69; 95% CI: 0.35-1.36; P = 0.27).
Conclusions: Poorer RVPAC reflects higher baseline risk and mortality, regardless of treatment. T-TEER is associated with better survival across a range of RVPAC values, including those less than previously suggested thresholds.
Keywords: hemodynamics; right heart failure; transcatheter tricuspid valve repair; tricuspid regurgitation.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Rommel is supported by a research grant from the Else-Kroener-Fresenius-Foundation. Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Estevez-Loureiro is a consultant to Abbott Vascular, Boston Scientific, and Edwards Lifesciences. Dr Maisano consults for Abbott Vascular, Medtronic, Edwards Lifesciences, Perifect, Xeltis, Transseptal Solutions, Magenta, and Cardiovalve; has received grant support from Abbott Vascular, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific, NVT, and Terumo; has received royalties from Edwards Lifesciences and 4Tech; and is a cofounder and shareholder of Transseptal Solutions, 4Tech, Cardiovalve, Magenta, Perifect, Coregard, and SwissVortex. Dr Ludwig has received travel compensation from Edwards Lifesciences; has received advisory fees from Bayer; has received speaker honoraria from Abbott; and is a consultant for NVT. Dr has Karam received consulting fees from Abbott, Medtronic, and Boston Scientific. Dr Adamo has received speaker honoraria from Abbott Vascular and Edwards Lifesciences. Dr Metra has received consulting fees from Abbott Vascular, Actelion, Amgen, AstraZeneca, Bayer, Edwards Therapeutics, LivaNova, Servier, Vifor Pharma, and WindTree Therapeutics. Dr von Bardeleben has received research grants from and has served as a principal investigator for Abbott, Edwards Lifesciences, and Medtronic. Dr Luedike has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Edwards Lifesciences; and has received research honoraria from Edwards Lifesciences. Dr Toggweiler has received honoraria from Medtronic, Boston Scientific, Biosensors, Hi-D Imaging, Abbott Vascular, Medira, Shockwave Medical, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, and Daiichi-Sankyo; has received institutional research grants from Edwards Lifesciences, Abbott Vascular, Boston Scientific, Fumedica, Novartis, Boehringer Ingelheim, and Polares Medical; and holds equity in Hi-D Imaging. Dr Boekstegers has received consulting fees from Abbott and Edwards Lifesciences. Dr Rück has received consulting fees from Boston Scientific, Edwards Lifesciences, and Abbott. Dr Hausleiter has received consulting fees from Edwards Lifesciences. Dr Lurz has received consulting fees from ReCor, Edwards Lifesciences, Abbott, and Innoventric; and has received royalties from Innoventric. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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