Right ventricular function-pulmonary pressure interaction as a predictor of mortality in tricuspid regurgitation.

Abstract

Right ventricular-pulmonary arterial (RV-PA) coupling reflects the ability of the right ventricle to adapt contractile performance to pulmonary afterload. Although TAPSE/PASP has been associated with outcomes across several cardiovascular conditions, its prognostic role in heterogeneous tricuspid regurgitation (TR) populations remains incompletely defined. To evaluate the association between RV-PA coupling, assessed by TAPSE/PASP, and mortality in patients with TR, and to explore whether a composite index integrating longitudinal and areal right ventricular function, (TAPSE × FAC)/PASP, provides incremental prognostic information. In this retrospective cohort study, 247 patients with any grade of TR and available echocardiographic measurements of TAPSE and PASP were included. RV-PA coupling was assessed using TAPSE/PASP, and patients were stratified according to the cohort median. A composite index, (TAPSE × FAC)/PASP, was also evaluated. The primary outcome was all-cause mortality. Cox proportional hazards regression and receiver-operating characteristic analysis were used to assess associations with mortality and discriminatory performance. A pre-specified subgroup analysis was performed in patients with moderate-to-severe TR, defined as EROA ≥ 0.30 cm². Among 247 patients, the median age was 80 years and 61% were female. Reduced TAPSE/PASP was associated with higher 1-year mortality compared with preserved TAPSE/PASP (41.9% vs. 16.3%, p < 0.001) and remained independently associated with mortality after multivariable adjustment (HR 2.15, 95% CI 1.35-3.43, p = 0.001). In the moderate-to-severe TR subgroup (n = 88), TAPSE/PASP retained prognostic significance (HR 2.74, 95% CI 1.42-5.28, p = 0.003). The composite index showed a modest improvement in discrimination compared with TAPSE/PASP alone (AUC 0.691 vs. 0.669). In this retrospective TR cohort, reduced TAPSE/PASP was independently associated with all-cause mortality, with consistent findings in patients with moderate-to-severe TR. The composite (TAPSE × FAC)/PASP index provided only modest incremental discrimination and should be considered exploratory and hypothesis-generating pending external validation.