Pre-transplant right ventricle-to-pulmonary artery uncoupling on echocardiography and risk of early mortality after heart transplantation
D Couto-Mallon, D Enriquez-Vaquez, M Antunez-Ballesteros, G Barge-Caballero, E Barge-Caballero, M Padilla-Bautista, M J Paniagua-Martin, A Bouzas-Mosquera, M Gonzalez-Barbeito, M Solla-Buceta, A Hurtado-Doce, P Blanco-Canosa, J M Vazquez-Rodriguez, J J Cuenca-Castillo, M G Crespo-LeiroAbstract
Introduction
Right ventricle-to-pulmonary artery coupling, assessed by using the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio on transthoracic echocardiography (TTE), has been associated with prognosis in patients with heart failure and pulmonary hypertension.
Purpose
To evaluate the prognostic relevance of the pre–heart transplantation (HT) TAPSE/PASP ratio on post-transplant survival.
Methods
We conducted a retrospective study of patients aged >18 years who underwent HT between January 2010 and December 2024 at a single centre. Recipients with congenital heart disease, long-term ventricular assist devices, multiorgan transplantation, or re-transplantation were excluded. The TAPSE/PASP ratio was obtained from the last pre-transplant TTE. Patients were categorised into tertiles according to TAPSE/PASP. Survival was assessed using Kaplan–Meier analysis. The impact of TAPSE/PASP on short- (30, 90, and 180 days), mid- (1 year), and long-term mortality was evaluated using Cox proportional hazards regression. Median follow-up was 6.1 years.
Results
TAPSE/PASP was available in 262 of 304 transplant recipients (mean age 57 years, 21% women, 39% urgent HT). The characteristics of study population are summarized on table 1. Eighty-six recipients were classified in the first tertile (T1: TAPSE/PASP ≤0.32 mm/mmHg; median 0.27, IQR 0.23–0.29), 86 in the second tertile (T2: TAPSE/PASP >0.32 and ≤0.44; median 0.38, IQR 0.35–0.40), and 90 in the third tertile (T3: median TAPSE/PASP 0.53 mm/mmHg; IQR 0.47–0.65). T1 recipients had significantly lower survival than those in T2+T3 at 30, 90, and 180 days (88.4% vs 95.5%, 83.7% vs 92.6%, and 81.4% vs 89.8%; p=0.036, p=0.026, and p=0.028, respectively), but not thereafter (Figure). In multivariable Cox regression analysis, a pre-transplant TAPSE/PASP ratio ≤0.32 mm/mmHg was an independent predictor of 30-day post-HT mortality (adjusted HR 3.45, 95% CI 1.25–9.52; p=0.017), with no significant association with subsequent mortality.
Conclusion
A low pre-transplant TAPSE/PASP ratio identifies recipients at increased risk of mortality within the first 30 days after HT, but is not associated with worse long-term survival.Table 1For image description, please refer to the figure legend and surrounding text.FigureFor image description, please refer to the figure legend and surrounding text.