What is the clinical evidence from this study?

Study design: Cohort. Population: Tricuspid regurgitation (n=247). Intervention: Reduced TAPSE/PASP ratio vs. Preserved TAPSE/PASP ratio. Primary outcome: All-cause mortality at 1 year (HR 2.15, 95% CI 1.35-3.43, p=0.001).

What question did this study set out to answer?

This research examines the relationship between right ventricular-pulmonary arterial coupling and mortality in tricuspid regurgitation patients.

June 16, 2026Open Access

Right ventricular function–pulmonary pressure interaction as a predictor of mortality in tricuspid regurgitation

Key Result

Reduced TAPSE/PASP ratio was independently associated with higher 1-year all-cause mortality compared with preserved TAPSE/PASP (41.9% vs. 16.3%, HR 2.15) in patients with tricuspid regurgitation.

Key Points

This research examines the relationship between right ventricular-pulmonary arterial coupling and mortality in tricuspid regurgitation patients.
Retrospective cohort study of 247 patients with tricuspid regurgitation and echocardiographic data.
Assessed RV-PA coupling using TAPSE/PASP and a composite index (TAPSE × FAC)/PASP.
Cox proportional hazards regression and ROC analysis evaluated mortality associations.
Reduced TAPSE/PASP was linked to higher 1-year mortality (41.9% vs. 16.3%, p < 0.001).
After adjustments, TAPSE/PASP was independently associated with mortality (HR 2.15, 95% CI 1.35-3.43, p = 0.001).
In moderate-to-severe TR, TAPSE/PASP maintained prognostic significance (HR 2.74, 95% CI 1.42-5.28, p = 0.003).

Study Design

Type

Cohort (n=247)

Multicenter

Structured PICO

Does reduced RV-PA coupling (assessed by TAPSE/PASP) predict increased all-cause mortality in patients with tricuspid regurgitation?

Population

247 patients with any grade of tricuspid regurgitation, median age 80 years and 61% female, followed for up to 3 years to assess all-cause mortality.

Exposure

Reduced right ventricular-pulmonary arterial (RV-PA) coupling, defined as TAPSE/PASP ≤ 0.404 mm/mmHg (cohort median)

Comparator

Preserved RV-PA coupling, defined as TAPSE/PASP > 0.404 mm/mmHg

Outcome

All-cause mortality at 1 yearhard clinical

In patients with tricuspid regurgitation, reduced RV-PA coupling (assessed by TAPSE/PASP) is a strong, independent predictor of 1-year all-cause mortality, highlighting its utility for non-invasive risk stratification.

Main Result

Hazard Ratio: 2.15 (95% CI 1.35–3.43)

Absolute Event Rate: 41.9% vs 16.3%

p-value: p=0.001

Limitations

Retrospective, single-center study introducing potential selection bias and residual confounding
Included patients with varying degrees of TR severity, with a substantial proportion having mild TR
Detailed etiologic subclassification of TR was not systematically available
Echocardiographic parameters were derived from clinical reports without systematic offline re-measurement
TAPSE/PASP is load-dependent and relies on Doppler-derived estimates of PASP which may be less accurate in severe TR
Valvular interventions during follow-up were not modeled as time-dependent covariates
The proposed composite index and derived cut-off values were not externally validated

Abstract

Right ventricular-pulmonary arterial (RV-PA) coupling reflects the ability of the right ventricle to adapt contractile performance to pulmonary afterload. Although TAPSE/PASP has been associated with outcomes across several cardiovascular conditions, its prognostic role in heterogeneous tricuspid regurgitation (TR) populations remains incompletely defined. To evaluate the association between RV-PA coupling, assessed by TAPSE/PASP, and mortality in patients with TR, and to explore whether a composite index integrating longitudinal and areal right ventricular function, (TAPSE × FAC)/PASP, provides incremental prognostic information. In this retrospective cohort study, 247 patients with any grade of TR and available echocardiographic measurements of TAPSE and PASP were included. RV-PA coupling was assessed using TAPSE/PASP, and patients were stratified according to the cohort median. A composite index, (TAPSE × FAC)/PASP, was also evaluated. The primary outcome was all-cause mortality. Cox proportional hazards regression and receiver-operating characteristic analysis were used to assess associations with mortality and discriminatory performance. A pre-specified subgroup analysis was performed in patients with moderate-to-severe TR, defined as EROA ≥ 0.30 cm². Among 247 patients, the median age was 80 years and 61% were female. Reduced TAPSE/PASP was associated with higher 1-year mortality compared with preserved TAPSE/PASP (41.9% vs. 16.3%, p < 0.001) and remained independently associated with mortality after multivariable adjustment (HR 2.15, 95% CI 1.35-3.43, p = 0.001). In the moderate-to-severe TR subgroup (n = 88), TAPSE/PASP retained prognostic significance (HR 2.74, 95% CI 1.42-5.28, p = 0.003). The composite index showed a modest improvement in discrimination compared with TAPSE/PASP alone (AUC 0.691 vs. 0.669). In this retrospective TR cohort, reduced TAPSE/PASP was independently associated with all-cause mortality, with consistent findings in patients with moderate-to-severe TR. The composite (TAPSE × FAC)/PASP index provided only modest incremental discrimination and should be considered exploratory and hypothesis-generating pending external validation.

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