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
- 1Department of Cardiology, Istanbul Medipol University, Medipol Mega University Hospital, Istanbul, Turkey
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 (2015–2025). 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.
Related
- Prognostic value of preprocedural neutrophil percentage-to-albumin ratio for in-hospital and overall mortality in patients with reduced ejection fraction undergoing transcatheter aortic valve implantation
- Coronary artery disease management in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomised controlled trials
- Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report
- Outcomes of Hemodialysis Patients Undergoing Contemporary Transcatheter Aortic Valve Implantation ― Insights From the LAPLACE-TAVI Registry ―
- Multicenter experience of hybrid transcatheter pulmonary valve implantation in patients with a large right ventricular outflow tract
BibTeX
@article{akhundova2026prognostic,
title = {{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}},
author = {Aysel Akhundova and Berhan Keskin and Umeyir Savur and Aykun Hakgor and Özlem Önder and Fatih E. Olgun and Atakan Dursun and Hacı M. Güneş and Beytullah Çakal and Bilal Boztosun},
journal = {Postepy w kardiologii interwencyjnej = Advances in interventional cardiology},
year = {2026},
month = sep,
doi = {10.5114/aic.2026.164566},
url = {https://europepmc.org/article/PMC/PMC13721080},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - 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
AU - Aysel Akhundova
AU - Berhan Keskin
AU - Umeyir Savur
AU - Aykun Hakgor
AU - Özlem Önder
AU - Fatih E. Olgun
AU - Atakan Dursun
AU - Hacı M. Güneş
AU - Beytullah Çakal
AU - Bilal Boztosun
PY - 2026
DA - 2026/09/01
JO - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology
DO - 10.5114/aic.2026.164566
UR - https://europepmc.org/article/PMC/PMC13721080
AB - 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 (2015–2025). 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.
SN - 1734-9338
SN - 1897-4295
ER -