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<p>Right ventricular–pulmonary arterial (RV–PA) coupling reflects the ability of the right ventricle to adapt contractile performance to pulmonary afterload. Although TAPSE/PASP has been associated with outcomes across several cardiovascular conditions, its prognostic role in heterogeneous tricuspid regurgitation (TR) populations remains incompletely defined. To evaluate the association between RV–PA coupling, assessed by TAPSE/PASP, and mortality in patients with TR, and to explore whether a composite index integrating longitudinal and areal right ventricular function, (TAPSE × FAC)/PASP, provides incremental prognostic information. In this retrospective cohort study, 247 patients with any grade of TR and available echocardiographic measurements of TAPSE and PASP were included. RV–PA coupling was assessed using TAPSE/PASP, and patients were stratified according to the cohort median. A composite index, (TAPSE × FAC)/PASP, was also evaluated. The primary outcome was all-cause mortality. Cox proportional hazards regression and receiver-operating characteristic analysis were used to assess associations with mortality and discriminatory performance. A pre-specified subgroup analysis was performed in patients with moderate-to-severe TR, defined as EROA ≥ 0.30&#xa0;cm². Among 247 patients, the median age was 80 years and 61% were female. Reduced TAPSE/PASP was associated with higher 1-year mortality compared with preserved TAPSE/PASP (41.9% vs. 16.3%, <i>p</i> &lt; 0.001) and remained independently associated with mortality after multivariable adjustment (HR 2.15, 95% CI 1.35–3.43, <i>p</i> = 0.001). In the moderate-to-severe TR subgroup (<i>n</i> = 88), TAPSE/PASP retained prognostic significance (HR 2.74, 95% CI 1.42–5.28, <i>p</i> = 0.003). The composite index showed a modest improvement in discrimination compared with TAPSE/PASP alone (AUC 0.691 vs. 0.669). In this retrospective TR cohort, reduced TAPSE/PASP was independently associated with all-cause mortality, with consistent findings in patients with moderate-to-severe TR. The composite (TAPSE × FAC)/PASP index provided only modest incremental discrimination and should be considered exploratory and hypothesis-generating pending external validation.</p> Graphical abstract <p></p>

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Right ventricular function–pulmonary pressure interaction as a predictor of mortality in tricuspid regurgitation

  • 期刊论文

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  • 发表日期：

    2026年6月15日

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  • Yogev Peri,
  • Yan Topilsky,
  • Mohammad Alnees,
  • Haitham Abu Khadija

摘要

Right ventricular–pulmonary arterial (RV–PA) coupling reflects the ability of the right ventricle to adapt contractile performance to pulmonary afterload. Although TAPSE/PASP has been associated with outcomes across several cardiovascular conditions, its prognostic role in heterogeneous tricuspid regurgitation (TR) populations remains incompletely defined. To evaluate the association between RV–PA coupling, assessed by TAPSE/PASP, and mortality in patients with TR, and to explore whether a composite index integrating longitudinal and areal right ventricular function, (TAPSE × FAC)/PASP, provides incremental prognostic information. In this retrospective cohort study, 247 patients with any grade of TR and available echocardiographic measurements of TAPSE and PASP were included. RV–PA coupling was assessed using TAPSE/PASP, and patients were stratified according to the cohort median. A composite index, (TAPSE × FAC)/PASP, was also evaluated. The primary outcome was all-cause mortality. Cox proportional hazards regression and receiver-operating characteristic analysis were used to assess associations with mortality and discriminatory performance. A pre-specified subgroup analysis was performed in patients with moderate-to-severe TR, defined as EROA ≥ 0.30 cm². Among 247 patients, the median age was 80 years and 61% were female. Reduced TAPSE/PASP was associated with higher 1-year mortality compared with preserved TAPSE/PASP (41.9% vs. 16.3%, p < 0.001) and remained independently associated with mortality after multivariable adjustment (HR 2.15, 95% CI 1.35–3.43, p = 0.001). In the moderate-to-severe TR subgroup (n = 88), TAPSE/PASP retained prognostic significance (HR 2.74, 95% CI 1.42–5.28, p = 0.003). The composite index showed a modest improvement in discrimination compared with TAPSE/PASP alone (AUC 0.691 vs. 0.669). In this retrospective TR cohort, reduced TAPSE/PASP was independently associated with all-cause mortality, with consistent findings in patients with moderate-to-severe TR. The composite (TAPSE × FAC)/PASP index provided only modest incremental discrimination and should be considered exploratory and hypothesis-generating pending external validation.

Graphical abstract