Impaired right ventricle-pulmonary artery coupling (RVFW/PASP ratio < -0.42%/mm Hg) before Cardioband tricuspid annuloplasty was associated with significantly decreased survival (p=0.02).
Cohort (n=59)
Does RV-PA coupling status predict all-cause mortality in patients undergoing transcatheter tricuspid annuloplasty with the Cardioband system?
RV-PA coupling assessed by the RVFW/PASP ratio is a significant predictor of all-cause mortality in patients undergoing transcatheter tricuspid annuloplasty.
p-value: p=0.02
Abstract Background The right ventricle-pulmonary artery (RV-PA) coupling is the standard method to assess the right ventricle (RV) function. The RV-PA coupling involves the RV ability to adjust its myocardial contractility (end-systolic elastance) to the arterial afterload (arterial elastance). There are multiple RV-PA coupling measurements associated with prognostic significance, including the tricuspid annular plane systolic excursion (TAPSE)/PA systolic pressure (PASP) ratio and the RV free wall strain (RVFW)/PASP ratio. Nevertheless, no outcomes associated with RV function measurements after transcatheter tricuspid annuloplasty have been reported, so little is known about the impact of these parameters in patients who underwent this procedure with the Cardioband system. Purpose To evaluate the prognostic significance of the RV-PA coupling in patients undergoing transcatheter tricuspid annuloplasty with the Cardioband system. Methods Patients with significant tricuspid regurgitation who underwent Cardioband tricuspid annuloplasty from September 2019 to December 2024 were prospectively enrolled. All patients had a comprehensive echocardiogram and right heart catheterization before the procedure. Clinical outcomes of patients were stratified according to RV-PA coupling and uncoupling with both the TAPSE/PASP ratio (cut-off value of 0.36 mm/mm Hg for uncoupling) and the RVFW/PASP ratio (cut-off value of –0.42%/mm Hg for uncoupling). Both cut-off values were based on prior studies’ reported values. The primary endpoint of survival analysis was all-cause mortality. The Kaplan-Meier method was used to estimate the cumulative event rates, which were compared by means of the log-rank test. Results A total of 59 patients were included with a mean age of 78 ± 7 years, most of them female (83%). The mean follow-up was 25 ± 17 months and all-cause mortality was 19%. RV-PA coupling measured with the TAPSE/PASP ratio showed no significant difference in survival (log-rank test, p = 0.25). On the other hand, survival significantly decreased in patients with impaired coupling with a RVFW/RVP ratio –0.42%/mm Hg with mean follow-up of 19 ± 17 months when compared to those with normal coupling with a mean follow-up of 30 ± 17 months (log-rank test, p = 0.02). Conclusions A normal RV-PA coupling before a Cardioband procedure is associated with a significant decrease in all-cause mortality. Our results suggest that RV-PA coupling using the RVFWS/PASP ratio appears to be a novel and better predictor of prognosis than the TAPSE/PASP ratio in patients undergoing tricuspid annuloplasty with the Cardioband system; however, further studies are needed to improve risk stratification and patient selection.Survival estimate with TAPSE/PASP ratio Survival estimate with RVFWS/PASP ratio
Salinas-Casanova et al. (Sat,) conducted a cohort in significant tricuspid regurgitation (n=59). Impaired RV-PA coupling (RVFW/PASP ratio < -0.42%/mm Hg) vs. Normal RV-PA coupling was evaluated on all-cause mortality (p=0.02). Impaired right ventricle-pulmonary artery coupling (RVFW/PASP ratio < -0.42%/mm Hg) before Cardioband tricuspid annuloplasty was associated with significantly decreased survival (p=0.02).