AI-predicted mean pulmonary artery pressure (TAPSE/mPAPpredicted) was superior to standard echocardiography in predicting 2-year mortality after TTVI (AUC 0.633 vs 0.586; P=0.008).
Observational (n=737)
Yes
Does an AI-enabled assessment of RV-PA coupling using predicted mPAP improve the prediction of 2-year mortality compared to standard echocardiographic parameters in patients undergoing TTVI for severe TR?
An AI-enabled echocardiographic assessment of RV-PA coupling accurately predicts mean pulmonary artery pressure and improves risk stratification for 2-year mortality in patients undergoing transcatheter tricuspid valve intervention.
Effect estimate: AUC 0.633 vs 0.586
p-value: p=0.008
AIMS: Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters. METHODS AND RESULTS: This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R: 0.68; P value: 1.3 × 10-8). Moreover, predicted mPAP (mPAPpredicted) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography) levels in predicting 2-year mortality after TTVI area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10-6. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10-4). CONCLUSION: Artificial intelligence-enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling.
Fortmeier et al. (Wed,) conducted a observational in Severe tricuspid regurgitation undergoing transcatheter tricuspid valve interventions (n=737). AI-predicted mean pulmonary artery pressure (TAPSE/mPAPpredicted) vs. Standard echocardiographic systolic pulmonary artery pressure (TAPSE/sPAPechocardiography) was evaluated on Prediction of 2-year mortality after TTVI (AUC 0.633 vs 0.586, p=0.008). AI-predicted mean pulmonary artery pressure (TAPSE/mPAPpredicted) was superior to standard echocardiography in predicting 2-year mortality after TTVI (AUC 0.633 vs 0.586; P=0.008).
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