961 RIGHT VENTRICLE-PULMONARY ARTERY COUPLING RATIO AS PROGNOSTIC FACTOR FOR PATIENTS WITH SEVERE AORTIC STENOSIS UNDERGOING TAVI

Abstract

Abstract Background Right Ventricle/Pulmonary Artery (RV/PA) coupling has recently emerged as a relevant prognostic factor in patients undergoing transcatheter valvular interventions. The aim of this study is to assess the interaction between RV/PA coupling ratio and the incidence of Acute Kidney Injury (AKI) following TAVI in patients with severe aortic stenosis. Furthermore we investigated the interaction between this novel ratio and adverse events at 24 months follow-up. Methods A population of 283 patients was selected from the Verona Valvular Registry (CESC n =1918). RV/PA coupling was estimated as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPs) obtained through transthoracic echocardiograms. AKI was defined as an increase in serum creatinine (sCr) of at least 0.3 mg/dL up to 48 hours following TAVI. Major adverse cardiovascular events (MACEs) were defined as the composite occurrence of cardiac death, re-hospitalization for congestive heart failure and stroke. Results Mean age was 83.4 ± 5.36 years and 41.3% of patients were female. The median value of TAPSE/PAPs ratio was 0.5667 mm/mmHg and was used as a cut-off. A TAPSE/PASP ratio <0.5667 was found to be associated with a higher incidence of MACE at Kaplan Meyer analysis at 24 months (10.4% vs 3.5%, log p = 0.004) and higher occurrence of AKI (17.0% vs. 7.7%; p=0.027). Notably TAPSE/PAPs interquartile comparison showed higher incidence for AKI in patients in the lowest quartile compared to higher ones (24.2% vs. 8.5%; p = 0.001). Following Cox multivariate analysis, TAPSE/PAPs ratio and diabetes mellitus were found to be independent predictors of AKI. Furthermore, risk for 24 months MACEs was higher in the population with lower TAPSE/PAPs ratio (HR 2.672; CI 95% [1.195–5.974]; p = 0.017). Conclusion RV/PA coupling, as characterized by TAPSE/PAPs ratio, is a promising independent predictor of AKI, also associated with higher risk of major adverse cardiac events at follow-up in subjects undergoing TAVI. These data suggest a possible role for this novel index in risk stratification, assessment of the prognosis, and decision-making in these patients.