Cardiovascular Ultrasound · Published 2026-08-02 · DOI 10.1186/s12947-026-00379-1
Francesco Putortì, Tommaso Fabris, Consolato Mesiani, Simone Tripi, Michele Strosio, Marco Garaventa, Antonella Capomolla, Andrea Panza, Giulio Sasso, Samiha Tamanna, Anna Pedagna, Antonella Cecchetto, Francesco Cardaioli, Giulia Masiero, Luca Nai Fovino, Chiara Fraccaro, Massimo Napodano, Giuseppe Tarantini
Abstract Introduction Right ventricular–pulmonary artery (RV-PA) uncoupling, expressed as the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/PAPs) ratio, is a negative prognostic indicator in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). This study aims to investigate the association between the echocardiographically measured TAPSE/PAPs ratio and invasively determined pulmonary hypertension (PH) subtypes in this population, with the goal of identifying patients at higher risk. Methods This study is a retrospective analysis of 667 patients who underwent TAVR for native severe symptomatic AS at our center between January 2015 and December 2022. All patients underwent a comprehensive transthoracic echocardiographic evaluation and right heart catheterization prior to the procedure. PH was classified into: no PH, isolated post-capillary PH (IpcPH), and combined pre- and post-capillary PH (CoPH). Follow-up time was defined as the time from the procedure to the last documented contact with the patient (alive) or to the time of documented death. All-cause mortality at two years was the primary endpoint. Results eTAPSE/PAPs showed a moderately positive correlation with pulmonary vascular resistance (Spearman’s Rho = 0.52; p = 0.025) and was associated with CoPH (odds ratio 1.29, 95% confidence interval 1.10–1.30). ROC curve analysis showed that eTAPSE/PAPs discriminated presence of CoPH with an AUC of 0.740. The optimal cut-off value was 0.29 mm/mmHg (sensitivity 72%, specificity 60%). During follow-up, 157 deaths were recorded. Kaplan-Meier curves showed a significant difference in overall mortality at 2 years when patients were stratified according to eTPASE/PAPs ratio value of 0.29 (log rank = 4.94, p = 0.026). Conclusions The eTAPSE/PAPs ratio identifies patients with symptomatic AS undergoing TAVR with higher risk of CoPH. These patients can benefit from an RHC to refine pre-operative risk assessment. Graphical Abstract
Abstract from DOAJ. Public domain (CC0 1.0).
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Putortì, F., Fabris, T., Mesiani, C., et al. (2026). Right ventricular-pulmonary artery uncoupling identifies higher risk of combined pulmonary hypertension in patients undergoing TAVR. Cardiovascular Ultrasound. https://doi.org/10.1186/s12947-026-00379-1