Cahill Thomas J, Pibarot Philippe, Yu Xiao, Babaliaros Vasilis, Blanke Philipp, Clavel Marie-Annick, Douglas Pamela S, Khalique Omar K, Leipsic Jonathon, Makkar Raj, Alu Maria C, Kodali Susheel, Mack Michael J, Leon Martin B, Hahn Rebecca T
Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York City, New York, USA.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
JACC Cardiovasc Interv. 2022 Sep 26;15(18):1823-1833. doi: 10.1016/j.jcin.2022.07.005.
Physiologic right ventricle-pulmonary artery (RV-PA) coupling may be impaired in patients with aortic stenosis (AS).
This study aimed to assess the incidence and prognostic significance of impaired RV-PA coupling in low-risk patients with symptomatic severe AS undergoing transcatheter aortic valve replacement or surgical aortic valve replacement.
RV-PA coupling was measured by transthoracic echocardiography as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) in patients in the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial. The primary endpoint was the composite of all-cause mortality, stroke, and rehospitalization at the 2-year follow-up.
Among 570 low-risk patients included in the analysis, RV-PA uncoupling was defined by a TAPSE/PASP ratio ≤ 0.55 mm/mm Hg. At baseline, 222 of 570 (38.9%) patients had RV-PA uncoupling. At 2 years, patients with baseline RV-PA uncoupling had an increased incidence of the primary endpoint (19.1% vs 9.9%, P = 0.002), all-cause mortality (5.9% vs 0.6%, P < 0.001), cardiovascular mortality (4.1% vs 0.6%, P = 0.003), and rehospitalization (13.5% vs 7.3%, P = 0.018). On multivariable analysis, baseline RV-PA uncoupling remained an independent predictor of the primary endpoint at 2 years (HR: 1.92; 95% CI: 1.04-3.57; P = 0.038).
In patients with symptomatic severe AS at low surgical risk undergoing transcatheter aortic valve replacement or surgical aortic valve replacement, baseline RV-PA uncoupling defined by TAPSE/PASP ≤ 0.55 mm Hg was associated with adverse clinical outcomes at 2 years, including all-cause mortality, cardiovascular mortality, and rehospitalization.
主动脉瓣狭窄（AS）患者的生理性右心室-肺动脉（RV-PA）耦合可能受损。
本研究旨在评估接受经导管主动脉瓣置换术或外科主动脉瓣置换术的有症状重度AS低风险患者中RV-PA耦合受损的发生率及其预后意义。
在PARTNER（主动脉经导管瓣膜置入）3试验中，通过经胸超声心动图测量RV-PA耦合，即三尖瓣环平面收缩期位移（TAPSE）与肺动脉收缩压（PASP）之比。主要终点是2年随访时的全因死亡率、卒中及再次住院的复合终点。
纳入分析的570例低风险患者中，RV-PA解耦定义为TAPSE/PASP比值≤0.55 mm/mm Hg。基线时，570例患者中有222例（38.9%）存在RV-PA解耦。2年时，基线存在RV-PA解耦的患者主要终点发生率增加（19.1%对9.9%，P = 0.002），全因死亡率增加（5.9%对0.6%，P < 0.001），心血管死亡率增加（4.1%对0.6%，P = 0.003），再次住院率增加（13.5%对7.3%，P = 0.018）。多变量分析显示，基线RV-PA解耦仍是2年时主要终点的独立预测因素（HR：1.92；95%CI：1.04 - 3.57；P = 0.038）。
在接受经导管主动脉瓣置换术或外科主动脉瓣置换术且手术风险较低的有症状重度AS患者中，由TAPSE/PASP≤0.55 mm Hg定义的基线RV-PA解耦与2年时不良临床结局相关，包括全因死亡率、心血管死亡率及再次住院。
