Right ventricular-pulmonary arterial coupling in transcatheter structural heart interventions

Area of Science:

• Cardiology
• Cardiac Physiology
• Interventional Cardiology

Background:

• Right ventricular-pulmonary arterial (RV-PA) coupling evaluates right heart function by assessing the interaction between the right ventricle and pulmonary arteries.
• RV-PA coupling is a key prognostic indicator in structural heart interventions like TAVI, TEER, and tricuspid therapies.
• Impaired RV-PA coupling, often indicated by echocardiographic surrogates (e.g., TAPSE/PASP ratio), correlates with higher mortality and heart failure hospitalizations.

Purpose of the Study:

• To highlight the prognostic significance of RV-PA coupling in patients undergoing structural heart interventions.
• To discuss the limitations of current non-invasive methods for assessing RV-PA coupling.
• To emphasize the need for improved RV-PA coupling assessment for enhanced clinical decision-making.

Main Methods:

• Review of existing literature on RV-PA coupling in structural heart disease interventions.
• Analysis of echocardiographic surrogates (e.g., TAPSE/PASP) for RV-PA coupling assessment.
• Comparison of non-invasive indices with invasive pressure-volume loop assessments.

Main Results:

• Impaired RV-PA coupling is consistently linked to adverse clinical outcomes, including increased mortality.
• RV-PA coupling can dynamically change post-intervention, with improvement suggesting better prognosis.
• Current non-invasive methods for assessing RV-PA coupling exhibit moderate correlation with invasive measures and lack standardization.

Conclusions:

• RV-PA coupling is a valuable prognostic tool in structural heart interventions, but current assessment methods have significant limitations.
• Standardization of RV-PA coupling assessment techniques and establishment of evidence-based thresholds are crucial for routine clinical application.
• Further research is needed to refine RV-PA coupling assessment for improved risk stratification and patient management.