RV-PA uncoupling in cardiac amyloidosis patients doubled all-cause mortality risk (RR 2.07) and nearly tripled cardiovascular mortality risk (RR 2.97).
Does RV-PA uncoupling predict all-cause mortality, cardiovascular mortality, and heart failure hospitalization in patients with cardiac amyloidosis?
RV-PA uncoupling, assessed non-invasively via the TAPSE/PASP ratio, is a significant predictor of mortality and heart failure hospitalization in patients with cardiac amyloidosis.
Absolute Event Rate: 0% vs 0%
Abstract Background Cardiac amyloidosis (CA) often leads to heart failure (HF) with preserved left ventricular ejection fraction, while also affecting right ventricular (RV) function and its ability to adapt to changes in afterload. Right ventricular-pulmonary arterial (RV-PA) coupling is a crucial indicator of this property, with its prognostic importance been recently investigated in various cardiovascular diseases. Purpose The aim of this systematic review and meta-analysis is to investigate the prognostic significance of RV-PA coupling in patients with CA. Methods We conducted a systematic literature search for studies assessing the prognostic role of RV-PA coupling in patients with CA. We recorded the method of RV-PA coupling assessment, the used cutoffs, patients’ age, sex, and follow-up duration. The outcomes of interest were all-cause mortality (ACM), cardiovascular mortality (CVM), hospitalization for HF (HHF), as well as combined endpoints (ACM+HHF, CVM+HHF) at maximal follow-up. We extracted the event rates for those endpoints according to RV-PA coupling, as defined by each study. Pooling of the risk ratios was conducted according to a random effects model. I2 was chosen as the measure of between-study heterogeneity, with values exceeding 50% being considered significant. Results We identified a total of 88 studies, of which 6 were ultimately selected for data extraction and inclusion in the meta-analysis after screening of title/abstract/full-text. All studies used the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP), with cutoffs ranging from 0.31 to 0.47mm/mmHg. Studies included elderly patients with mean age exceeding 70 years, with male sex predominance. The follow-up duration ranged from 6 to 23 months. According to the results of the meta-analysis, compared to the RV-PA coupling group, the presence of RV-PA uncoupling was associated with high rates of ACM (RR: 2.07, 95% CI: 1.50-2.85, p0.0001), CVM (RR: 2.97, 95% CI: 1.60-5.53, p=0.0006), and HHF (RR: 2.69, 95% CI: 1.28-5.66, p=0.009) (Figure 1). We also observed an increased incidence of the combined endpoints (ACM+HHF, RR: 1.97, 95% CI: 1.29-3.00, p=0.002; CVM+HHF, RR: 2.18, 95% CI: 1.50-3.18) (Figure 1). There was evidence of moderate between-study heterogeneity in almost all the performed analyses. Conclusion Our systematic review and meta-analysis highlight the prognostic impact of RV-PA uncoupling in patients with CA. RV-PA uncoupling through the TAPSE/PASP ratio was consistently associated with a higher risk of major adverse cardiovascular events, suggesting that it may serve as a valuable non-invasive marker for risk stratification in this high-risk population. However, the observed between-study heterogeneity underscores the need for further research to refine cutoff values and validate these findings in larger, prospective cohorts.Figure 1 Figure 2
Theofilis et al. (Sat,) reported a other. RV-PA uncoupling in cardiac amyloidosis patients doubled all-cause mortality risk (RR 2.07) and nearly tripled cardiovascular mortality risk (RR 2.97).