Echocardiographic atrial and right heart to pulmonary circulation coupling indices identify high-risk patients in moderate aortic stenosis

Q: What are the key findings of this study?

Reduced TAPSE/PASP ( 5.17, HR 3.16) independently predicted mortality in moderate AS, with combined uncoupling conferring a 10.91-fold higher risk (p<0.0001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Moderate aortic stenosis (n=135). Intervention: Combined right ventricular-pulmonary arterial uncoupling (TAPSE/PASP 5.17 mL·s·cm⁻¹·m⁻²) vs. Preserved coupling (normal TAPSE/PASP ≥ 0.67 mm/mmHg and normal LACI ≤ 5.17 mL·s·cm⁻¹·m⁻²). Primary outcome: All-cause mortality (HR 10.91, 95% CI 4.14-28.78, p=<0.0001).

Q: What does this research mean for the field?

Reduced right ventricular-pulmonary circulation coupling (TAPSE/PASP) and elevated left atrial coupling (LACI) are independently associated with markedly increased mortality in patients with moderate aortic stenosis. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the prognostic value of right ventricular-pulmonary circulation coupling (TAPSE/PASP) and left atrial volumetric/mechanical coupling (LACI) in patients with moderate aortic stenosis.

Gloria Santangelo; Andrea Faggiano; Giulio Pio Federico Mallardi; Michele Baroni; Luca Dionisi; Alessandro Guareschi; Guido Pasero; Fabiola Sozzi; Massimiliano Ruscica; Marco Guazzi; Stefano Carugo; Francesca Bursi

doi:10.1016/j.ijcard.2026.135029

October 29, 2026International Journal of CardiologyOpen Access

Echocardiographic atrial and right heart to pulmonary circulation coupling indices identify high-risk patients in moderate aortic stenosis

View Full Paper

Ask AI

Bookmark

Share

Key result

Combined RV-PA and LA uncoupling is linked to ~10.9-fold higher mortality in moderate AS.

HR 10.91
95% CI 4.14-28.78
P<0.0001
n=135

Why the study?

Do echocardiographic coupling indices (TAPSE/PASP and LACI) predict all-cause mortality in patients with moderate aortic stenosis?

Key Points

To assess the prognostic value of right ventricular-pulmonary circulation coupling (TAPSE/PASP) and left atrial volumetric/mechanical coupling (LACI) in patients with moderate aortic stenosis.
Retrospective, single-center analysis of 135 patients with moderate aortic stenosis and preserved mean left ventricular ejection fraction (57.8 ± 9%).
Echocardiographic indices were evaluated: TAPSE/PASP as a surrogate of right ventricular-pulmonary arterial coupling and LACI (ratio of left atrial volume index to mitral a' velocity).
Follow-up averaged 1.61 ± 0.79 years, tracking the primary endpoint of all-cause mortality.
During follow-up, 33 patients (24%) died; reduced TAPSE/PASP (< 0.67 mm/mmHg) and elevated LACI (> 5.17 mL·s·cm⁻¹·m⁻²) independently predicted mortality with adjusted HRs of 3.03 (p = 0.0024) and 3.16 (p = 0.0034), respectively.
Patients with both right and left coupling impairment exhibited markedly lower 1-year survival (49% ± 10%) compared to single uncoupling (77% ± 6%) and preserved coupling (95% ± 2%; log-rank p < 0.0001; HR: 10.91, 95% CI 4.14–28.78).

Study Design

Type

Cohort (n=135)

Multicenter

No

Structured PICO

Do echocardiographic coupling indices (TAPSE/PASP and LACI) predict all-cause mortality in patients with moderate aortic stenosis?

P

Population

135 older adults (mean age 78 years, 47.4% female) in sinus rhythm with moderate aortic stenosis and preserved ejection fraction, free of significant concomitant valve disease or prior valve surgery, followed for a mean of 1.61 years.

E

Exposure

Echocardiographic evaluation of right ventricular-pulmonary circulation coupling via tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP) and left atrial volumetric/mechanical coupling index (LACI, ratio of left atrial volume index to mitral annular a' velocity)

C

Comparator

Patients stratified by ROC-derived thresholds: preserved coupling (TAPSE/PASP ≥ 0.67 mm/mmHg and LACI ≤ 5.17 mL·s·cm⁻¹·m⁻²; Group 1), single uncoupling of either parameter (Group 2), or combined uncoupling of both parameters (Group 3)

O

Outcome

All-cause mortality at a mean follow-up of 1.61 ± 0.79 years, ascertained by review of electronic medical records including the National Health System of Lombardy Region databasehard clinical

Main Result

Hazard Ratio: 10.91 (95% CI 4.14–28.78)

Absolute Event Rate: 51% vs 5%

p-value: p=<0.0001

Limitations

Single-center, retrospective study design
Relatively small sample size (n = 135)
Exclusion of patients not in sinus rhythm at the time of echocardiography, limiting applicability to patients with persistent/permanent atrial fibrillation
ROC cut-offs for TAPSE/PASP and LACI were internally derived within the study cohort
Potential residual confounding by superimposed cardiac conditions or comorbidities (e.g., renal dysfunction, mitral regurgitation, pulmonary disease)
Retrospective, single-center study design
Exclusion of patients not in sinus rhythm at the time of TTE because reliable measurement of mitral annular a' velocity and LACI was not possible
Follow-up echocardiograms to assess hemodynamic progression were only available in a subset of 42 patients

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In patients with moderate aortic stenosis, echocardiographic indices of right ventricular-pulmonary arterial coupling (TAPSE/PASP < 0.67 mm/mmHg) and left atrial volumetric/mechanical coupling (LACI > 5.17) independently identify high-risk individuals with significantly worse survival.

Abstract

PURPOSE: Emerging evidence points on an increased mortality risk associated to moderate aortic stenosis (AS), yet this population remains insufficiently characterized. We tested the prognostic value of two echocardiographic coupling indices reflecting right and left-sided cardiac function: the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP) and the left atrial volumetric/mechanical coupling index (LACI). METHODS: Retrospective, single-center study including 135 patients with moderate AS. TAPSE/PASP was used as a non-invasive surrogate of right ventricular-pulmonary circulation (RV-Pc) coupling, and LACI was defined as ratio of left atrial volume index to mitral a' velocity. The primary endpoint was all-cause mortality. Cox regression and Kaplan-Meier analyses were used to assess the prognostic value of both indices. RESULTS: During a mean follow-up of 1.61 ± 0.79 years, 33 patients (24%) died. Reduced TAPSE/PASP (< 0.67 mm/mmHg) and elevated LACI (> 5.17) were independently associated with an increased mortality (HR: 3.03 and 3.16, respectively, p < 0.01). These associations remained significant even after adjusting for age. Stratification into three groups - preserved, single, or combined uncoupling -showed progressively lower 1-year survival rates, ranging from 95% to 49% (p < 0.0001). None of the coupling-derived variables was associated with hemodynamic progression or need of aortic valve replacement. CONCLUSION: TAPSE/PASP and LACI are independently associated with mortality in patients with moderate AS. These parameters may provide incremental prognostic information in this often-overlooked population. These findings may prompt further studies evaluating the potential role of these parameters in helping to refine prognostic phenotyping.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Santangelo et al. (2026) conducted a cohort in Moderate aortic stenosis (n=135). Combined right ventricular-pulmonary arterial uncoupling (TAPSE/PASP < 0.67 mm/mmHg) and left atrial volumetric/mechanical uncoupling (LACI > 5.17 mL·s·cm⁻¹·m⁻²) vs. Preserved coupling (normal TAPSE/PASP ≥ 0.67 mm/mmHg and normal LACI ≤ 5.17 mL·s·cm⁻¹·m⁻²) was evaluated on All-cause mortality (HR 10.91, 95% CI 4.14-28.78, p=<0.0001). Reduced TAPSE/PASP (<0.67, HR 3.03) and elevated LACI (>5.17, HR 3.16) independently predicted mortality in moderate AS, with combined uncoupling conferring a 10.91-fold higher risk (p<0.0001).

synapsesocial.com/papers/6aefbd4950d2071ffda4bba7 https://doi.org/10.1016/j.ijcard.2026.135029

View Full Paper

Ask AI

Bookmark

Share

Echocardiographic atrial and right heart to pulmonary circulation coupling indices identify high-risk patients in moderate aortic stenosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Echocardiographic atrial and right heart to pulmonary circulation coupling indices identify high-risk patients in moderate aortic stenosis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading