The following is a summary of “Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI,” published in the May 2024 issue of Cardiology by Steffan et al.

Right Ventricular (RV) dysfunction has often been overlooked in patients getting transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). 

Researchers conducted a prospective study to determine how RV-to-pulmonary artery coupling (RV/PAc) predicts mortality after TAVI for AS, considering different AS flow types. 

They assessed all patients with AS who underwent TAVI at their center from 2018 to 2020, analyzing 862 patients. Using a ROC analysis (cut-off 0.512 mm/mmHg), the cohort was split into 429 patients with preserved and 433 patients with reduced RV/PAc.

The results showed that reduced RV/PAc correlated with male sex and more comorbidities. Short-term VARC-3 outcomes and NYHA classes were similar. Reduced RV/PAc linked to higher 2-year all-cause mortality (35.0% [30.3%-39.3%] vs. 15.4% [11.9% -18.7%], hazard ratio 2.5 [1.9-3.4], P<0.001), with triple cardiovascular mortality. Results held consistency after statistical adjustments. Sub-analyses of AS flow types showed reduced RV/PAc in classical and paradoxical low-flow low-gradient AS (74% and 59%). However, RV/PAc retained its predictive value in subgroups. 

Investigators concluded that identifying RV dysfunction through low RV/PAc must be included in future TAVI risk evaluations as it is a powerful predictor of mortality after TAVI, regardless of flow type. 

Source: link.springer.com/article/10.1007/s00392-024-02457-8