Right Ventricular–Pulmonary Artery Coupling in Tricuspid Regurgitation

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-06-09 DOI:10.1016/j.jcin.2025.04.033

Karl-Philipp Rommel MD , Florian Schlotter MD , Lukas Stolz MD , Karl-Patrik Kresoja MD , Mohammad Kassar MD , Fabien Praz MD , Rodrigo Estevez-Loureiro MD , Francesco Maisano MD , Eric Van Belle MD , Guillaume Bonnet MD , Daniel Kalbacher MD , Sebastian Ludwig MD , Christos Iliadis MD , Nicole Karam MD , Vera Fortmeier MD , Marianna Adamo MD , Marco Metra MD , Ralph Stephan von Bardeleben MD , Philipp Lauten MD , Peter Luedike MD , Philipp Lurz MD

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引用次数: 0

Abstract

Background

Right ventricular–pulmonary artery coupling (RVPAC) predicts outcomes after transcatheter tricuspid valve edge-to-edge repair (T-TEER), but its role in patient selection remains unclear.

Objectives

The aim of this study was to evaluate the prognostic implications of RVPAC in a European registry of patients with tricuspid regurgitation undergoing either T-TEER or medical management.

Methods

Among 1,885 patients with tricuspid regurgitation (n = 585 medical, n = 1,300 T-TEER), 946 were propensity matched (1:1). RVPAC, assessed as the ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure was analyzed for its association with 1-year mortality.

Results

RVPAC was significantly associated with mortality (HR: 0.11; 95% CI: 0.04-0.29; P < 0.01), with an optimized cutoff of 0.41 mm/mm Hg. Mortality differed significantly by RVPAC in both treatment groups (log-rank P < 0.01). Across RVPAC tertiles (<0.32, 0.32-0.46, and >0.46 mm/mm Hg), tricuspid annular plane systolic excursion increased (14 mm [Q1-Q3: 12-17 mm] vs 18 mm [Q1-Q3: 15-20 mm] vs 21 mm [Q1-Q3: 18-24 mm]; P < 0.01), while systolic pulmonary artery pressure (60 mm Hg [Q1-Q3: 50-70 mm Hg] vs 45 mm Hg [Q1-Q3: 40-52 mm Hg] vs 34 mm Hg [Q1-Q3: 29-41 mm Hg]; P = 0.30) and kidney function (43 mL/min/m² [Q1-Q3: 30-57 mL/min/m²] vs 49 mL/min/m² [Q1-Q3: 38-67 mL/min/m²] vs 53 mL/min/m² [Q1-Q3: 40-69 mL/min/m²]; P = 0.03) declined. Mortality was highest in the low RVPAC tertile, with no difference between treatment modalities (HR: 1.04; 95% CI: 0.68-1.61; P = 0.85). T-TEER was associated with better survival than medical management in the intermediate RVPAC tertile (HR: 0.54; 95% CI: 0.31-0.94; P = 0.03). This difference persisted but weakened in the high RVPAC tertile, with the overall most favorable outcomes (HR: 0.69; 95% CI: 0.35-1.36; P = 0.27).

Conclusions

Poorer RVPAC reflects higher baseline risk and mortality, regardless of treatment. T-TEER is associated with better survival across a range of RVPAC values, including those less than previously suggested thresholds.

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三尖瓣反流的右心室-肺动脉耦合

背景：右心室-肺动脉耦合（RVPAC）预测经导管三尖瓣边缘修复（T-TEER）后的预后，但其在患者选择中的作用尚不清楚。目的本研究的目的是评估RVPAC在欧洲三尖瓣反流患者中接受T-TEER或医学治疗的预后意义。方法1885例三尖瓣反流患者（医学585例，T-TEER 1300例）中，倾向匹配946例（1:1）。RVPAC评估为三尖瓣环平面收缩偏移与收缩期肺动脉压的比值，分析其与1年死亡率的关系。结果rvpac与死亡率显著相关(HR: 0.11；95% ci: 0.04-0.29；P & lt;0.01)，最佳临界值为0.41 mm/mm Hg。两组RVPAC的死亡率差异显著(log-rank P <；0.01)。三尖瓣环平面收缩偏移增加（14 mm [Q1-Q3: 12-17 mm] vs 18 mm [Q1-Q3: 15-20 mm] vs 21 mm [Q1-Q3: 18-24 mm]），三尖瓣环平面收缩偏移增加（<0.32, 0.32和>；0.46 mm/mm Hg）；P & lt;肺动脉收缩压(60 mm Hg [Q1-Q3: 50-70 mm Hg] vs 45 mm Hg [Q1-Q3: 40-52 mm Hg] vs 34 mm Hg [Q1-Q3: 29-41 mm Hg]；P = 0.30)和肾功能(43 mL/min/m2 [Q1-Q3: 30-57 mL/min/m2] vs 49 mL/min/m2 [Q1-Q3: 38-67 mL/min/m2] vs 53 mL/min/m2 [Q1-Q3: 40-69 mL/min/m2]；P = 0.03)下降。低RVPAC不育的死亡率最高，治疗方式之间没有差异(HR: 1.04；95% ci: 0.68-1.61；P = 0.85)。在中期RVPAC患者中，T-TEER比医疗管理与更好的生存率相关(HR: 0.54；95% ci: 0.31-0.94；P = 0.03)。这种差异持续存在，但在高RVPAC组中减弱，总体结果最有利(HR: 0.69；95% ci: 0.35-1.36；P = 0.27)。结论无论治疗方法如何，sporer RVPAC均反映较高的基线风险和死亡率。T-TEER在RVPAC值范围内与更好的生存率相关，包括那些低于先前建议阈值的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.