Key result
Higher TAPSE/RVSP ratio linked to ~18% lower mortality per 0.1 mm/mmHg after aortic coarctation repair.
Why the study?
The prognostic value of right ventricular to pulmonary artery (RV-PA) coupling in adults with repaired coarctation of aorta is unknown.
Does the TAPSE/RVSP ratio predict all-cause mortality and heart failure hospitalization in adults with repaired coarctation of aorta and normal RV systolic function?
Cohort (n=509)
No
Does the TAPSE/RVSP ratio predict all-cause mortality and heart failure hospitalization in adults with repaired coarctation of aorta and normal RV systolic function?
Effect estimate: HR 0.82 (95% CI 0.78-0.86)
p-value: p=<0.001
The TAPSE/RVSP ratio is an independent predictor of all-cause mortality and heart failure hospitalization in adults with repaired coarctation of the aorta and normal RV systolic function, improving prognostic risk models.
Supports TAPSE/RVSP ratio for mortality risk stratification in repaired coarctation; hypothesis-generating and requires prospective validation.
Background: Right ventricular (RV) systolic dysfunction and pulmonary hypertension is present in 20 % of adults with repaired coarctation of aorta (COA). However, the prognostic value of RV to pulmonary artery (RV-PA) coupling in this population is unknown. The purpose of this study was to assess the relationship between RV-PA coupling and clinical outcomes (heart failure hospitalization and all-cause mortality) in this population. Methods: Retrospective cohort study of adults with repaired COA and normal RV systolic function defined as RV free wall strain ≥ -24 %. RV-PA coupling was assessed using tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) ratio. Results: Of 509 patients (median age 32 [20-45] years; men 290 [57 %]), the average TAPSE and RVSP were 22 ± 5 mm and 33 ± 9 mmHg, respectively, and TAPSE/RVSP ratio was 0.78 (0.56-0.96) mm/mmHg. Of 509 patients, 51 (10 %) died and 43 (8 %) were hospitalized for heart failure during a median follow-up of 8.5 (4.9-10.4) years. TAPSE/RVSP was associated with all-cause mortality (hazard ratio 0.82, 95 % confidence interval 0.78-0.86, per 0.1 mm/mmHg), and heart failure hospitalization (hazard ratio 0.86, 95 % confidence interval 0.79-0.93, per 0.1 mm/mmHg) after adjustment for anatomic lesions, cardiovascular interventions, comorbidities, and echocardiographic indices. The inclusion of TAPSE/RVSP ratio in the risk models improved prognostic power of the models to predict all-cause mortality (C-statistics difference 0.046, p < 0.001), and heart failure hospitalization (C-statistics difference 0.031, p = 0.007). Conclusions: TAPSE/RVSP ratio was associated with outcomes in COA patients with normal RV systolic function, suggesting that abnormal RV-PA coupling may be present prior to the onset of overt RV systolic function in this population.
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Egbe et al. (2025) conducted a cohort in Repaired coarctation of aorta (n=509). TAPSE/RVSP ratio was evaluated on All-cause mortality (HR 0.82, 95% CI 0.78-0.86, p=<0.001). In adults with repaired coarctation of the aorta and normal right ventricular systolic function, each 0.1 mm/mmHg increase in TAPSE/RVSP ratio was associated with an 18% decreased risk of all-cause mortality.
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