Key result
Lower baseline TAPSE/PASP linked to ~2.4-fold higher HF hospitalizations or CV death after AFR shunting.
Why the study?
Heterogeneous outcomes have been reported with interatrial shunting in heart failure, and whether baseline RV-PA coupling is associated with clinical outcomes after shunting was unknown.
Does impaired baseline right ventricular to pulmonary artery coupling (low TAPSE/PASP ratio) predict higher rates of cardiovascular death or heart failure hospitalization in patients with symptomatic heart failure undergoing Atrial Flow Regulator implantation?
Cohort (n=106)
Open-label
Non-randomized
Yes
Does impaired baseline right ventricular to pulmonary artery coupling (low TAPSE/PASP ratio) predict higher rates of cardiovascular death or heart failure hospitalization in patients with symptomatic heart failure undergoing Atrial Flow Regulator implantation?
In heart failure patients undergoing Atrial Flow Regulator interatrial shunting, impaired baseline RV–PA coupling (lower TAPSE/PASP ratio) is associated with higher rates of cardiovascular death and recurrent heart failure hospitalizations, highlighting its potential utility for patient selection.
Aims Heterogeneous outcomes were reported in studies targeting left atrial (LA) pressure reduction by interatrial shunting in heart failure (HF). Right ventricular (RV) performance and pulmonary arterial (PA) afterload are essential in assuring the efficient blood flow shunting through the pulmonary circulation. We investigated whether baseline RV–PA coupling, expressed as the tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio, is associated with outcomes after Atrial Flow Regulator (AFR) implantation in the PRELIEVE study. Methods and results In this post-hoc analysis of the multicentre, single-arm PRELIEVE study (NCT03030274), 106 patients with symptomatic HF (62 with reduced and 44 with preserved ejection fraction) underwent AFR implantation and were followed for 12 months. TAPSE/PASP was measured by echocardiography at baseline and 3 months. The primary composite endpoint was cardiovascular (CV) death or HF hospitalization (HFH). During follow-up, 19 patients (18%) experienced the composite endpoint. At baseline, these patients had higher NT-proBNP (1261 [567, 1790] vs. 317 [114, 1200] pg/mL; p=0.009) and lower TAPSE/PASP (0.43 [0.33–0.53] vs 0.53 [0.43–0.76], p=0.04). In Kaplan–Meier analysis, lowest TAPSE/PASP ratio tended to show the worst outcome (p=0.07). Using recurrent-event Poisson regression, lower baseline TAPSE/PASP was associated with a higher cumulative incidence of HFHs (incidence rate ratio 2.4 [95% CI 1.0–5.6] for lowest vs middle tertile, p=0.039). Conclusions In patients with HF undergoing interatrial shunting, impaired baseline RV–PA coupling assessed by a low TAPSE/PASP ratio was associated with higher rates of CV death or recurrent HF hospitalizations. The potential value of baseline RV–PA uncoupling in identifying responders to LA shunt therapies requires prospective evaluation in adequately powered prospective studies.
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Bakhshaliyev et al. (2026) conducted a cohort in Symptomatic heart failure with reduced or preserved ejection fraction undergoing Atrial Flow Regulator implantation (n=106). Impaired baseline right ventricular-to-pulmonary artery coupling (lowest tertile TAPSE/PASP <0.45 mm/mmHg) in patients implanted with an Atrial Flow Regulator vs. Middle tertile (0.45-0.65 mm/mmHg) or highest tertile (>0.65 mm/mmHg) of baseline TAPSE/PASP ratio was evaluated on Cumulative incidence of cardiovascular mortality and recurrent heart failure hospitalizations at 12 months (IRR 2.4, 95% CI 1.0-5.6, p=0.039). Lower baseline TAPSE/PASP (<0.45) was associated with a higher rate of recurrent HF hospitalizations or CV death after AFR shunting (IRR 2.4, 95% CI 1.0-5.6, p=0.039 vs middle tertile).
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