Background The prognostic significance of the trajectories of right ventricular-pulmonary artery (RV-PA) coupling after transcatheter aortic valve replacement (TAVR) remains underexplored. Objectives This study aimed to (1) characterize the short-term changes of RV-PA coupling (assessed by TAPSE/PASP ratio) from baseline to approximately 3 months after TAVR, and (2) analyze its association with clinical outcomes, including all-cause mortality. Methods In this retrospective analysis, a total of 210 severe AS patients undergoing TAVR from July 2017 to April 2023 were included based on complete information and were divided into four groups according to the longitudinal changes in RV-PA coupling status. RV-PA coupling was defined as the TAPSE/PASP ratio (normal coupling: 0.55; uncoupling: ≤0.55). Observations included all-cause mortality, heart failure rehospitalization, and NYHA functional class. Results Among those with normal RV-PA coupling at baseline ( n = 129), 87.6% (113/129) maintained preserved coupling at follow-up (Group 1), while 12.4% (16/129) developed new-onset uncoupling (Group 3). Of those with baseline RV-PA uncoupling ( n = 81), 72.8% (59/81) achieved normalization (Group 2), whereas 27.2% (21/81) exhibited persistent uncoupling (Group 4). Group 4 was associated with higher all-cause mortality (45.5% vs. 4.4%, P 0.05). Multivariable Cox regression analysis identified persistent RV-PA uncoupling as an independent predictor of mortality (HR: 5; 95% CI: 1.29–19.35; P = 0.02). Conclusion Persistent RV-PA uncoupling after TAVR independently predicts adverse outcomes. Serial assessment of RV-PA coupling enhances risk stratification, supporting tailored post-procedural management.
Zhou et al. (Thu,) studied this question.
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