, Berhan Keskin 2
, İsmail Balaban 1
, Halit Eminoğlu 1
, Barkın Kültürsay 3
, Baver Bozan 1
, Tezel Kovancı 1
, Doğan Şen 1
, Murat Karaçam 4
, Ferhat Keten 1
, Büşra Güvendi Şengör 1
, Rezzan Deniz Acar 1
, Ali Karagöz 1
, Elnur Alizade 1
2Department of Cardiology, Bağcılar Medipol Mega University Hospital, İstanbul, Türkiye
3Department of Cardiology, Tunceli State Hospital, Tunceli, Türkiye
4Department of Cardiology, Bitlis State Hospital, Bitlis, Türkiye
Abstract
Background: Right ventriculo-pulmonary artery (RV–PA) coupling, commonly assessed by the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP), has emerged as an important prognostic marker in various cardiovascular diseases. However, its predictive value after transcatheter aortic valve implantation (TAVI) remains insufficiently defined. This study aimed to evaluate whether postoperative TAPSE/PASP is independently associated with long-term all-cause mortality in patients undergoing transfemoral TAVI.
Methods: We retrospectively analyzed 786 consecutive patients who underwent transfemoral TAVI between June 2020 and March 2025. Postoperative TAPSE/PASP was measured within the first week after the procedure. Receiver-operating characteristic (ROC) curve analysis determined the optimal TAPSE/PASP cut-off for predicting long-term mortality. Survival analyses were performed using the Kaplan–Meier method and Cox proportional hazards regression.
Results: During a median follow-up of 509 days (interquartile range: 283-847), 61 patients (9.0%) died. Receiver-operating characteristic (ROC) analysis identified 0.52 mm/mmHg as the optimal postoperative TAPSE/PASP cut-off (AUC = 0.626, P < .001, 95% CI: 0.57-0.68). Patients with TAPSE/PASP <0.52 (n = 278) had worse clinical, echocardiographic, and laboratory profiles than those with TAPSE/PASP ≥0.52 (n = 508). Kaplan–Meier analysis demonstrated significantly reduced survival in the lower TAPSE/PASP group (12.6% vs. 5.1% mortality, log-rank P < .001). In multiple Cox regression, age (HR = 1.044, P = .044, 95% CI: 1.001-1.089), chronic obstructive pulmonary disease (COPD) (HR = 2.261, P = .012, 95% CI: 1.192-4.290), and postoperative TAPSE/PASP (HR = 0.856 per 0.1 mm/mm Hg increase, P = .033, 95% CI: 0.743-0.988) remained independent predictors of long-term mortality.
Conclusions: Lower postoperative TAPSE/PASP (<0.52 mm/mmHg) is independently associated with increased long-term mortality after TAVI, supporting its use for early postoperative risk stratification.