The prognostic role of right ventricular-pulmonary arterial coupling in aortic stenosis patients undergoing TAVR: a systematic review and meta-analysis

The predictive role of right ventricular-pulmonary arterial (RV-PA) uncoupling following transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) is inconsistent. Thus, this meta-analysis aimed to evaluate the prognostic value of RV-PA coupling in patients undergoing TAVR. We systematically searched PubMed, Embase, and Web of Science databases for studies reporting the prognostic relevance of RV-PA coupling in patients undergoing TAVR. Fixed- or random-effects models were employed according to heterogeneity. Subgroup analyses were conducted to evaluate the influence of study characteristics on the analyzed results. Eighteen studies involving 5,905 patients were included. The pooled results demonstrated that RV-PA uncoupling prior to TAVR was associated with the increased all-cause mortality risk, with a hazard ratio (HR) of 2.36 (95% CI: 1.76–3.16) in univariate analysis and an adjusted hazard ratio (aHR) of 2.01 (95% CI: 1.40–2.89) in multivariate analysis. Moreover, both non-severe RV-PA (HR = 1.71, 95% CI: 1.02–2.86) and severe RV-PA uncoupling (HR = 2.73, 95% CI: 1.50–4.95) were associated with elevated mortality risk in univariate analysis. Multivariate analysis showed increased all-cause mortality risk in patients with non-severe/severe uncoupling, but these findings were not statistically significant. RV-PA uncoupling was identified as a predictor of adverse outcomes after TAVR. Incorporating assessment of RV-PA coupling may enhance risk stratification and prognostic prediction in the TAVR patient population. In both univariate and multivariate analyses, baseline RV-PA uncoupling was associated with increased all-cause mortality risk in TAVR patients. In the univariate analysis, patients with non-severe baseline RV-PA uncoupling exhibited a 1.71-fold higher risk of all-cause mortality, while those with severe uncoupling demonstrated a 2.73-fold higher risk. Postoperative RV-PA and the dynamics of RV-PA might contain more comprehensive prognostic information, but additional validation data are required to substantiate this hypothesis. TAPSE/PASP, given its non-invasive nature and simplicity, may serve as a clinically feasible surrogate for RV-PA coupling to facilitate risk stratification and prognostic evaluation in TAVR patients.