Prognostic value of right ventricular-pulmonary arterial coupling in adults with repaired coarctation of aorta

• Published in: International journal of cardiology congenital heart disease Vol. 21; p. 100608
• Main Authors: Egbe, Alexander C., Miranda, William R., Jain, Charles, Connolly, Heidi M., Burchill, Luke J., Borlaug, Barry A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2025; Elsevier
• Subjects: Cardiovascular; Mortality; Original; Prognostication; Pulmonary hypertension; Right heart failure; Right heart function; RV; Mortality; CI; RVSP; FAC; HR; LV; PASP; TAPSE; Pulmonary hypertension; RV-PA; Ees; Prognostication; COA; Right heart failure; RVFWS; Right heart function; Ea; Hazard ratio; End-systolic elastance; Arterial elastance; Fractional area change; Right ventricular systolic pressure; Pulmonary artery systolic pressure; Right ventricle; Coarctation of aorta; Left ventricle; Confidence interval; Tricuspid annular plane systolic excursion; Right ventricle to pulmonary artery; Right ventricular free wall strain
• ISSN: 2666-6685; 2666-6685
• DOI: 10.1016/j.ijcchd.2025.100608

Right ventricular (RV) systolic dysfunction and pulmonary hypertension is present in 20 % of adults with repaired coarctation of aorta (COA). However, the prognostic value of RV to pulmonary artery (RV-PA) coupling in this population is unknown. The purpose of this study was to assess the relationship between RV-PA coupling and clinical outcomes (heart failure hospitalization and all-cause mortality) in this population. Retrospective cohort study of adults with repaired COA and normal RV systolic function defined as RV free wall strain ≥ -24 %. RV-PA coupling was assessed using tricuspid annular plane systolic excursion/RV systolic pressure (TAPSE/RVSP) ratio. Of 509 patients (median age 32 [20–45] years; men 290 [57 %]), the average TAPSE and RVSP were 22 ± 5 mm and 33 ± 9 mmHg, respectively, and TAPSE/RVSP ratio was 0.78 (0.56–0.96) mm/mmHg. Of 509 patients, 51 (10 %) died and 43 (8 %) were hospitalized for heart failure during a median follow-up of 8.5 (4.9–10.4) years. TAPSE/RVSP was associated with all-cause mortality (hazard ratio 0.82, 95 % confidence interval 0.78–0.86, per 0.1 mm/mmHg), and heart failure hospitalization (hazard ratio 0.86, 95 % confidence interval 0.79–0.93, per 0.1 mm/mmHg) after adjustment for anatomic lesions, cardiovascular interventions, comorbidities, and echocardiographic indices. The inclusion of TAPSE/RVSP ratio in the risk models improved prognostic power of the models to predict all-cause mortality (C-statistics difference 0.046, p < 0.001), and heart failure hospitalization (C-statistics difference 0.031, p = 0.007). TAPSE/RVSP ratio was associated with outcomes in COA patients with normal RV systolic function, suggesting that abnormal RV-PA coupling may be present prior to the onset of overt RV systolic function in this population.