Right ventricular-pulmonary artery coupling in tricuspid regurgitation: prognostic value and impact of treatment strategy
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 Europ...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
9 June 2025
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| In: |
JACC Cardiovascular interventions
Year: 2025, Volume: 18, Issue: 11, Pages: 1411-1421 |
| ISSN: | 1876-7605 |
| DOI: | 10.1016/j.jcin.2025.04.033 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jcin.2025.04.033 Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S193687982501297X 
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| Author Notes: | Karl-Philipp Rommel, MD, Florian Schlotter, MD, Lukas Stolz, MD, Karl-Patrik Kresoja, MD, Mohammad Kassar, MD, Fabien Praz, MD, Rodrigo Estevez-Loureiro, MD, Francesco Maisano, MD, Eric Van Belle, MD, Guillaume Bonnet, MD, Daniel Kalbacher, MD, Sebastian Ludwig, MD, Christos Iliadis, MD,Nicole Karam, MD, Vera Fortmeier, MD, Marianna Adamo, MD, Marco Metra, MD, Ralph Stephan von Bardeleben, MD, Philipp Lauten, MD, Peter Luedike, MD, Philip Raake, MD, Stefan Toggweiler, MD, Peter Boekstegers, MD, Anne Schöber, MD, Andreas Rück, MD, Tobias Geisler, MD, Mirjam Kessler, MD, Mathias H. Konstandin, MD, Tobias Kister, MD, Holger Thiele, MD, Alexander Lauten, MD, Jörg Hausleiter, MD,Philipp Lurz, MD, the Euro-TR Investigators |
| Summary: | 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. |
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| Item Description: | Online verfügbar: 9. Juni 2025 Gesehen am 29.10.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1876-7605 |
| DOI: | 10.1016/j.jcin.2025.04.033 |