The Prognostic Value of Right Ventricle–Pulmonary Artery Coupling in Valve Interventions

Abstract

BACKGROUND: Right ventricle-pulmonary artery (RV-PA) coupling is prognostically important in valvular heart disease. OBJECTIVES: The authors performed a systematic review and meta-analysis to quantify the association of RV-PA coupling with clinical endpoints after intervention for aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). METHODS: The primary outcome was all-cause mortality, and the secondary outcome was a composite of major adverse cardiovascular events (MACE). A random-effects model was used to compute pooled effect estimates, and summary receiver-operating characteristic curves identified optimal RV-PA thresholds. RESULTS: In total, 30 interventional studies (N = 12,992) met eligibility criteria, including 14 AS (n = 6,100), 12 MR (n = 5,032), and 4 TR (n = 1,860) studies. Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) was the most studied RV-PA coupling index. Reduced TAPSE/PASP was independently associated with all-cause mortality (AS adjusted HR: 1.69 [95% CI: 1.30-2.20]; MR adjusted HR: 1.94 [95% CI: 1.40-2.69]; P < 0.001) and the composite MACE (AS adjusted HR: 1.60 [95% CI: 1.29-2.00]; MR adjusted HR: 2.01 [95% CI: 1.54-2.62]; P < 0.001). There were significant nonlinear associations between TAPSE/PASP and adverse outcomes in AS and MR (P < 0.001). There were insufficient data to estimate a pooled effect-size in TR. Optimal TAPSE/PASP thresholds to predict all-cause mortality were ≤0.51 mm/mm Hg for AS interventions, ≤0.33 mm/mm Hg for MR interventions and ≤0.44 mm/mm Hg for TR interventions. CONCLUSIONS: TAPSE/PASP is an independent predictor of outcomes after interventions for AS and MR. The disease-specific TAPSE/PASP cutoffs could be integrated into risk-stratification models to better predict mortality before valve interventions and improve patient selection.

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