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The echocardiographic tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate of right ventricular-pulmonary arterial (RV-PA) coupling which corresponds well with the respective invasively derived index. Recently, a wealth of observational data has arisen, outlining its prognostic value in heart failure (HF) patients. To systematically appraise and quantitatively synthesize the evidence of the prognostic value of TAPSE/PASP ratio in left-sided HF regardless of etiology or left ventricular ejection fraction. A systematic literature review was conducted in electronic databases to identify studies reporting the association of TAPSE/PASP ratio with outcomes in patients with HF and, when appropriate, a random-effects meta-analysis was conducted to quantify the unadjusted and adjusted hazard ratios [(a)HRs] for all-cause death and the composite outcome of all-cause death or HF hospitalization. Eighteen studies were deemed eligible encompassing 8,699 HF patients. The applied cut-off value for RV-PA uncoupling varied substantially from 0.27 to 0.58 mm/mmHg, and in most studies values lower than the applied cutoff conveyed dismal prognosis. Eleven studies reported appropriate data for meta-analysis. TAPSE/PASP reduction by 1 mm/mmHg was independently associated with all-cause death (pooled aHR=1.32 [1.06-1.65]; p=0.01; I2=56%) and the composite outcome (pooled aHR=3.48 [1.67-7.25]; p<0.001; I2=0%). When a TAPSE/PASP cutoff value of 0.36 mm/mmHg was applied it yielded independent association with all-cause death (pooled aHR=2.84 [2.22-3.64]; p<0.001; I2=82%). RV-PA coupling assessed by echocardiographic TAPSE/PASP ratio appears to be an independent outcome predictor for HF patients. [ABSTRACT FROM AUTHOR]

Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and preserved ejection fraction who are at an elevated surgical risk for perioperative events. This review highlights a subset of the interventions available in clinical practice or in development for the treatment of these valvular and structural alterations. [ABSTRACT FROM AUTHOR]

Aims: Severe tricuspid regurgitation (TR) impairs prognosis in patients with left‐sided heart failure (HF) with preserved (≥50%, HFpEF) and reduced ejection fraction (<50%, HFrEF). Transcatheter tricuspid valve edge‐to‐edge repair (TTVR) potentially improves prognosis among patients with severe TR. We sought to assess the impact of left‐sided HF types on outcomes of TTVR. Methods and results: In this retrospective study, 71 HFpEF and 40 HFrEF patients, defined according to the European Society of Cardiology criteria, with isolated TR treated by TTVR in two tertiary care centres between 2016 and 2019 were analysed. The primary outcome was a composite outcome of all‐cause mortality and HF hospitalization at 12 months [median follow‐up 238 (interquartile range 175–365) days]. Additionally, a propensity score matching with a conservatively treated cohort of 914 patients with severe TR was performed. Procedural success did not differ between HFpEF (mean age 75.9 ± 9.3 years) or HFrEF (mean age 74.7 ± 9.1 years) patients (86% vs. 78%, P = 0.299). The primary endpoint occurred more frequently in patients with HFrEF as compared to HFpEF (50% vs. 30%, P = 0.016). Procedural success was associated with a reduced occurrence of the primary endpoint among patients with HFpEF (P < 0.001) but not HFrEF (P = 0.813), while both groups showed improvement in New York Heart Association functional class (both P < 0.001). After matching for age, EuroSCORE II, presence of a right ventricular lead and systolic pulmonary artery pressure, successful TTVR was associated with lower mortality as compared to conservative therapy in HFpEF patients (P = 0.020), but not in HFrEF patients (P = 0.274). Conclusion: Transcatheter tricuspid valve edge‐to‐edge repair might be a treatment option in patients with severe TR and HFpEF compared to conservative therapy. [ABSTRACT FROM AUTHOR]

While TTVR has been shown to be associated with a very low in-hospital mortality rate, perioperative mortality for isolated tricuspid valve repair ranges up to 10%. We thank Dr Ahmed and colleagues for their interest in our work regarding transcatheter tricuspid valve repair (TTVR) in the setting of heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF).1 Ahmed I et al i . wondered about the role of pulmonary capillary wedge pressure (PCWP), right ventricular (RV) function, pulmonary artery pressure (PAP) and the role of our data in comparison to surgical results of tricuspid repair. [Extracted from the article]

Pulmonary capillary wedge pressure (PCWP) as prognostic indicator in patients undergoing transcatheter valve repair (TTVR) of severe tricuspid regurgitation. We read with interest the article by Kresoja I et al i .1 regarding the potential of transcatheter tricuspid valve edge-to-edge repair (TTVR) to be a therapeutic avenue in heart failure patients with tricuspid regurgitation. [Extracted from the article]