Work

Prognostic value of pre- and post-procedural TAPSE/PASP ratio for long-term mortality in patients with left ventricular ejection fraction < 50% undergoing transcatheter aortic valve implantation

Year: 2026

Type: article

Abstract: Introduction: Tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio reflects right ventricular-pulmonary arterial (RV-PA) coupling and has prognostic value in heart failure and pulmonary hypertension.Its significance in patients with low ejection fraction (LVEF < 50%) undergoing transcatheter aortic valve implantation (TAVI) remains unclear.Aim: This study aimed to investigate the association between pre-procedural TAPSE/PASP ratio and long-term all-cause mortality and to determine whether post-TAVI TAPSE/PASP ratio assessed at discharge was associated with subsequent mortality in patients with severe AS and LVEF < 50%.Material and methods: This single-center retrospective study included 225 consecutive patients with severe aortic stenosis and LVEF < 50% undergoing TAVI (2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024)(2025).TAPSE/PASP was measured at baseline and discharge.The primary endpoint was all-cause mortality, analyzed using multivariable Cox regression.Results: Over a median follow-up of 1161 days, 102 (45.3%) patients died.Post-TAVI TAPSE/PASP was significantly higher in survivors (0.56 ±0.20 vs. 0.48 ±0.16 mm/mm Hg, p = 0.005) and was independently associated with long-term mortality (HR = 0.74 per 0.1 mm/mm Hg increase; 95% CI: 0.55-0.99;p = 0.04).Pre-TAVI TAPSE/PASP showed a borderline, non-significant association with mortality.Patients with post-TAVI TAPSE/PASP < 0.514 mm/mm Hg had significantly worse 5-year survival (log-rank p = 0.034). Conclusions:In severe aortic stenosis with LVEF < 50%, post-TAVI TAPSE/PASP at discharge was independently associated with long-term mortality.The findings suggest that assessment of RV-PA coupling after TAVI may provide additional prognostic information, although the clinical utility of the proposed threshold requires prospective validation.Key words: pulmonary hypertension, pulmonary artery systolic pressure, aortic stenosis, transcatheter aortic valve implantation, right ventricular, tricuspid annular plane systolic excursion. S u m m a r yThis study investigated the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio -a marker of right ventricular-pulmonary arterial (RV-PA) coupling -in 225 patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF < 50%) who underwent transcatheter aortic valve implantation (TAVI).Echocardiographic measurements were obtained before the procedure and at discharge.Over a median follow-up of approximately 3 years, 102 patients died.Survivors had significantly higher post-procedural TAPSE/PASP ratios compared to non-survivors.Multivariable analysis showed that the post-TAVI TAPSE/PASP ratio independently predicted longterm mortality, with each 0.1 mm/mmHg increase associated with a 26% reduction in mortality risk.The pre-procedural ratio, however, did not reach independent significance.Kaplan-Meier analysis confirmed worse 5-year survival in patients with a post-discharge TAPSE/PASP below 0.514 mm/mmHg.These findings suggest that persistent RV-PA uncoupling at discharge -rather than the pre-procedural status -is the stronger predictor of long-term mortality in this high-risk population, and that routine assessment of TAPSE/PASP after TAVI may improve risk stratification.

Source: Advances in Interventional Cardiology

DOI: 10.5114/aic.2026.164566