In moderate aortic stenosis, right ventricular-pulmonary artery uncoupling (RV phase) was associated with worse 5-year survival compared to normal coupling (HR 1.78; 95% CI 1.32-2.42; P<0.001).
Cohort (n=1,587)
Yes
Does right ventricular-pulmonary artery (RV-PA) uncoupling predict all-cause mortality in patients with moderate aortic stenosis?
In patients with moderate aortic stenosis, RV-PA uncoupling measured by echocardiography is independently associated with worse 5-year survival, offering a novel marker for risk stratification.
Hazard Ratio: 1.78 (95% CI 1.32–2.42)
p-value: p=<0.001
Abstract Background Right ventricular–pulmonary artery (RV-PA) coupling, which reflects matching of RV contractility over pulmonary resistance and measured by echocardiography as the ratio of tricuspid annular plane systolic excursion (TAPSE) and systolic PA pressure (sPAP), has emerged as a novel prognosticator in severe aortic stenosis (AS). However, its prognostic value in moderate AS has yet to be examined. Methods In this large retrospective multi-center study on patients with moderate AS, RV-PA coupling was first examined as a continuous variable, but to better understand the impact of each component of the ratio, RV-PA coupling was further defined as: (i) normal: normal pulmonary pressure (sPAP35 mmHg); (ii) pulmonic phase: isolated pulmonary hypertension (sPAP≥35 mmHg and TAPSE≥18mm); (iii) RV phase: combination of pulmonary hypertension and RV dysfunction (sPAP≥35 mmHg and TAPSE18mm). The cohort was further stratified according to these RV-PA coupling phases. Primary outcome was all-cause mortality at 5 years. Results A total of 1587 patients were included, of which 502 (32%) were classified in the pulmonic phase, 148 (9%) in the RV phase and 937 (59%) in the normal phase (Figure 1). Compared to the normal phase, patients in the pulmonic and RV phases had a higher prevalence of atrial fibrillation, increased prevalence of other valvular regurgitation, and larger left atrial volume index (all P0.001). Patients in the RV phase showed more symptoms, and lower peak aortic valve velocity and left ventricular (LV) ejection fraction as compared to patients in the pulmonic or normal phase (both P0.001). The Kaplan-Meier analysis revealed significant differences across the three phases overall and in pairwise comparisons (Figure 2). In multivariable analysis adjusting for age, sex, comorbidities, kidney function, symptoms, LV ejection fraction, E/e’, valvular regurgitation, and aortic valve replacement (as a time dependent covariate), the pulmonic (hazard ratio HR 1.40, 95% confidence interval CI 1.12-1.74, P=0.003) and RV phases (HR 1.78, 95% CI 1.32-2.42, P0.001) were independently associated with worse survival, with gradual increase in hazard ratio. When treating RV-PA coupling as a continuous variable, the restricted cubic spline showed a non-linear relationship with survival, and an optimal cutoff of 0.45 mm/mmHg was derived, which remained significantly associated with the outcome after adjusting for the same set of covariates (HR 1.71, 95% CI 1.35-2.16, P0.001). Conclusion In moderate AS, RV-PA uncoupling is independently associated with worse survival and offers potential to enhance risk stratification and optimize management guidance.
He et al. (Sat,) conducted a cohort in Moderate aortic stenosis (n=1,587). Right ventricular-pulmonary artery (RV-PA) uncoupling (RV phase) vs. Normal RV-PA coupling was evaluated on All-cause mortality at 5 years (HR 1.78, 95% CI 1.32-2.42, p=<0.001). In moderate aortic stenosis, right ventricular-pulmonary artery uncoupling (RV phase) was associated with worse 5-year survival compared to normal coupling (HR 1.78; 95% CI 1.32-2.42; P<0.001).