The present study evaluated the prognostic significance of right ventricular-pulmonary arterial (RV-PA) coupling, assessed by the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio, in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). This retrospective, single-center study involved 403 patients (mean age: 78.2 ± 8.4; 50.9% female). RV-PA coupling was categorized based on the pre-procedural TAPSE/sPAP ratio: severe uncoupling (≤0.32), moderate uncoupling (0.32–0.55), and normal coupling (>0.55). The study primary endpoints were in-hospital mortality and 2-year all-cause mortality. Multivariate logistic regression revealed that the TAPSE/sPAP ratio is an independent predictor of both in-hospital (adjusted OR: 0.61, 95% CI [0.44–0.84], P = .002) and 2-year mortality (adjusted OR: 0.69, 95% CI [0.56–0.85], P = .001). Severe uncoupling was strongly associated with increased 2-year mortality (adjusted OR: 3.92, 95% CI [1.67–9.20], P = .002). Our study establishes a significant association between reduced preoperative TAPSE/sPAP ratios and increased risks of both in-hospital and 2-year all-cause mortality in patients undergoing TAVI for severe AS. These results highlight the prognostic utility of evaluating RV-PA coupling. Incorporating this metric into preoperative risk stratification could potentially refine prognostic accuracy and inform clinical decision-making.

中文翻译：

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术前右心室与肺动脉耦合对经导管主动脉瓣植入术患者近期和远期预后的影响

本研究评估了接受经导管主动脉瓣植入术 (TAVI) 的患者中右心室 - 肺动脉 (RV-PA) 耦合的预后意义，通过三尖瓣环平面收缩期偏移与收缩期肺动脉压 (TAPSE/sPAP) 之比进行评估用于严重主动脉瓣狭窄（AS）。这项回顾性、单中心研究涉及 403 名患者（平均年龄：78.2 ± 8.4；50.9% 为女性）。RV-PA 耦合根据术前 TAPSE/sPAP 比率进行分类：重度解耦合 (≤0.32)、中度解耦合 (0.32–0.55) 和正常耦合 (>0.55)。该研究的主要终点是院内死亡率和 2 年全因死亡率。多变量逻辑回归显示，TAPSE/sPAP 比率是院内死亡率（调整后 OR：0.61，95% CI [0.44–0.84]，P = 0.002）和 2 年死亡率（调整后 OR：0.69， 95% CI [0.56–0.85]，P = .001）。严重脱钩与 2 年死亡率增加密切相关（调整后 OR：3.92，95% CI [1.67–9.20]，P = .002）。我们的研究发现，对于因严重 AS 接受 TAVI 的患者，术前 TAPSE/sPAP 比率降低与院内和 2 年全因死亡率风险增加之间存在显着关联。这些结果突出了评估 RV-PA 耦合的预后效用。将这一指标纳入术前风险分层可能会提高预后准确性并为临床决策提供信息。