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.