Comparison of Echocardiographic Right Ventricular-Pulmonary Arterial Coupling Indices in Patients Undergoing...

Tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) is an established prognostic marker in tricuspid regurgitation (TR). Right ventricular free wall longitudinal strain (RVFWS)/PASP has been proposed as more sensitive prognostic markers than TAPSE/PASP in patients with TR, yet its role in patients undergoing transcatheter tricuspid valve repair (TTVr) remains unclear. The objective of the study was to evaluate and compare the prognostic value of RVFWS/PASP and TAPSE/PASP with two different vendors in symptomatic TTVr cohorts.

TTVr-treated patients across three centers (2017-2023) were included. RVFWS was assessed using two vendors (A = GE EchoPAC and B = Tomtec). The primary endpoint was a composite of all-cause mortality or the first heart failure hospitalization at 2-years. Prognostic performance was assessed using Cox regression, C-statistics, and Kaplan-Meier analysis.

A total of 349 patients were included (137 vendor A and 212 vendor B). Patients in vendor B were older (83 vs. 80; p < 0.001), more symptomatic (New York Heart Association III/IV: 95.8 vs. 81.7%; p < 0.001), had lower 6-minute walk distance (218 vs. 282 m; p < 0.001), and greater right heart dilation, despite similar TR severity. RVFWS was higher in vendor B (23.0 vs. 18.0%, p < 0.001). RVFWS/PASP emerged as an independent predictor of the primary endpoint only in vendor A (hazard ratio per %/mmHg increase: 0.07, 95% CI: 0.01-0.46; p = 0.005), whereas TAPSE/PASP consistently showed independent prognostic association in both cohorts. Discrimination of both indices was not significantly different. Receiver operating characteristics-derived cutoffs identified patient subgroups with markedly different 2-year outcomes in both cohorts.

Both RVFWS/PASP and TAPSE/PASP provided modest prognostic value after TTVr, with TAPSE/PASP demonstrating consistent independent association across vendors.