ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
This article is part of the Research TopicExploring Right-Left Heart Interactions in Cardiovascular Disease: Mechanisms and ImplicationsView all 4 articles
Short-Term Changes of Right Ventricular-Pulmonary Artery Coupling After TAVR and Their Association with Clinical Outcomes
Provisionally accepted
- The Affiliated Hospital of Qingdao University, Qingdao, China
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Background: The prognostic significance of the trajectories of right ventricular-pulmonary artery (RV-PA) coupling after transcatheter aortic valve replacement (TAVR) remains underexplored. Objectives: This study aimed to (1) characterize the short-term changes of RV-PA coupling (assessed by TAPSE/PASP ratio) from baseline to approximately 3 months after TAVR, and (2) analyze its association with clinical outcomes, including all-cause mortality. Methods: In this retrospective analysis, a total of 210 severe AS patients undergoing TAVR from July 2017 to April 2023 were included based on complete information and were divided into four groups according to the longitudinal changes in RV-PA coupling status. RV-PA coupling was defined as the TAPSE/PASP ratio (normal coupling: >0.55; uncoupling: ≤0.55). Observations included all-cause mortality, heart failure rehospitalization, and NYHA functional class. Results: Among those with normal RV-PA coupling at baseline (n=129), 87.6% (113/129) maintained preserved coupling at follow-up (Group 1), while 12.4% (16/129) developed new-onset uncoupling (Group 3). Of those with baseline RV-PA uncoupling (n=81), 72.8% (59/81) achieved normalization (Group 2), whereas 27.2% (21/81) exhibited persistent uncoupling (Group 4). Group 4 was associated with higher all-cause mortality (45.5% vs. 4.4%, P<0.05). Multivariable Cox regression analysis identified persistent RV-PA uncoupling as an independent predictor of mortality (HR: 5; 95% CI: 1.29-19.35; P=0.02). Conclusion: Persistent RV-PA uncoupling after TAVR independently predicts adverse outcomes. Serial assessment of RV-PA coupling enhances risk stratification, supporting tailored post-procedural management.
Keywords: TAVR, RV-PA coupling, survival analysis, Echocardiography, Right ventricular function
Received: 08 Jul 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Ma, Zhou, Ju, Xia and Lian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhexun Lian, lianzx566@163.com
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