Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP), a good noninvasive approach for right ventricular to pulmonary artery (RV/PA) coupling, is of prognostic significance in many cardiovascular diseases. Yet, data regarding RV/PA coupling in transcatheter aortic valve replacement (TAVR) remain sparse.

To assess the change in TAPSE/sPAP between pre- and post-TAVR as well as its long-term prognostic value.

All patients who underwent TAVR for severe aortic stenosis between 2002 and 2022 at Rouen University Hospital, with an available TAPSE/sPAP assessed by echocardiography before and after procedure were included in this study. When available, TAPSE/sPAP was correlated with invasive right heart catheterization data. The primary endpoint was 5-years all-cause death or hospitalization for acute heart failure. C-tree analysis was used to find the best TAPSE/sPAP cut-off to be associated with the primary outcome.

Two hundred and sixty-nine patients were included in this analysis (median age 85 years, 57% women, 63% NYHA III-IV). Balloon expandable valves was implanted in 90% of cases. TAPSE/sPAP was significantly improved by TAVR (0.52 vs 0.58mm/mmHg, P=0.02). The lower the TAPSE/sPAP, the higher the NYHA functional class (P=0.0017), the higher the NTproBNP level (P<0.001) and the higher the Euroscore (P<0.001). TAPSE/sPAP had a good correlation with pulmonary artery elastance (r=–0.61, P<0.001). Using C-tree analysis, TAPSE/sPAP ≤0.55mm/mmHg was the best cut-off to be associated with the primary outcome (P=0.002). In multivariable Cox regression analysis, TAPSE/sPAP remained independently associated with the primary outcome even after adjustment with echocardiography (HR=0.20, 95%CI [0.04–0.89], P=0.03), comorbidities (HR=0.24, 95%CI [0.08–0.74], P=0.03) or Euroscore (HR=0.30, 95%CI [0.09–0.95], P=0.04). Both from baseline and follow-up assessment, patients with TAPSE/sPAP ≤0.55mm/mmHg had worse event-free survival (Fig. 1A–B). Interestingly, change in TAPSE/sPAP provided important prognostic value (Fig. 1C).

This study emphasizes the prognostic value of TAPSE/sPAP in the field of TAVR and suggest considering RV/PA coupling assessment not only before or after procedure but also the change in TAPSE/sPAP to identify patients at higher risk of worse outcome.