TOPLINE

In patients with heart failure (HF), a lower tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) ratio — a marker of right ventricular-PA (RV-PA) coupling — was associated with higher rates of cardiovascular death or HF hospitalisation after interatrial shunting.

METHODOLOGY

• Researchers conducted an exploratory analysis of a prospective open-label pilot study (PRELIEVE) to assess whether RV-PA coupling is associated with clinical outcomes after implantation of an interatrial shunting device.
• They included 106 patients aged 18 years or older with symptomatic HF (62 with reduced ejection fraction and 44 with preserved ejection fraction) who underwent implantation of an interatrial shunting device across 15 sites in Germany, Turkey, and Belgium between November 2017 and December 2020. Patients were followed up for 12 months.
• RV-PA coupling was estimated using the TAPSE/PASP ratio on echocardiography at baseline and 3 months.
• Most patients (81%) received a device with an 8-mm fenestrated diameter if pulmonary capillary wedge pressure (PCWP) was above 15 mm Hg at rest, whereas the remaining 19% received a device with a 10-mm diameter if PCWP was below 15 mm Hg at rest or ≥ 25 mm Hg during exercise.
• Patients were grouped by the median TAPSE/PASP ratio (0.53) and by tertiles (< 0.45, 0.45-0.65, > 0.65) to assess associations with clinical outcomes.

TAKEAWAY

• At 12 months, 18% of patients experienced cardiovascular death or HF hospitalisation. Those with events had a significantly lower baseline TAPSE/PASP ratio (0.43 vs 0.53; P = .04) and higher N-terminal pro-B-type natriuretic peptide levels (1261 vs 317 pg/mL; P = .009) than those without events.
• Patients in the lowest TAPSE/PASP tertile (< 0.45) had significantly higher rates of recurrent cardiovascular events than those in the middle tertile (incidence rate ratio [IRR], 2.4) and the highest tertile (IRR, 3.9; P < .05 for both).
• A median-based analysis showed a similar trend toward worse outcomes among patients with lower TAPSE/PASP ratios, although the difference was not statistically significant.
• Patients who remained free from events showed an improvement in the TAPSE/PASP ratio at 3 months, whereas those who experienced events continued to have lower coupling ratios.

IN PRACTICE

"Our findings conceptually endorse how contextualizing RV systolic function to its afterload within the RV-PA coupling, may capture the fundamental condition enabling efficient and safe interatrial shunting," the researchers of the study wrote.

"The hypothesis generating finding that reduced RV-PA coupling may identify potential clinical non-responders to left atrial decompression should be further validated in adequately powered prospective studies," they added.

SOURCE

The study was led by Nijad Bakhshaliyev, Ege Hospital, Baku, Azerbaijan. It was published online on June 27, 2026, in ESC Heart Failure.

LIMITATIONS

The single-arm, non-randomised design of the PRELIEVE study without a control group limited the causal interpretation of the findings. Changes in background medical therapy or medication adherence during follow-up may have influenced outcomes as concomitant treatments were not systematically tracked. The relatively small sample size precluded reliable subgroup analyses across HF phenotypes.

DISCLOSURES

The PRELIEVE study received sponsorship from Occlutech. One author disclosed receiving consultant fees from Occlutech and served as a principal investigator of the AFR-AFTER registry sponsored by Occlutech. Another author reported receiving support from Deutsche Forschungsgemeinschaft and Deutsche Herzstiftung, and his institution received scientific support from multiple medical device companies; he also received speaker honoraria or consulting fees from various healthcare, pharmaceutical, and medical technology companies until May 2024.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.