Rommel, Karl-PhilippKarl-PhilippRommelSchlotter, FlorianFlorianSchlotterStolz, LukasLukasStolzKresoja, Karl-PatrikKarl-PatrikKresojaKassar, MohammadMohammadKassar0000-0002-7576-2224Praz, FabienFabienPrazEstevez-Loureiro, RodrigoRodrigoEstevez-LoureiroMaisano, FrancescoFrancescoMaisanoVan Belle, EricEricVan BelleBonnet, GuillaumeGuillaumeBonnetKalbacher, DanielDanielKalbacherLudwig, SebastianSebastianLudwigIliadis, ChristosChristosIliadisKaram, NicoleNicoleKaramFortmeier, VeraVeraFortmeierAdamo, MariannaMariannaAdamoMetra, MarcoMarcoMetraStephan von Bardeleben, RalphRalphStephan von BardelebenLauten, PhilippPhilippLautenLuedike, PeterPeterLuedikeRaake, PhilipPhilipRaakeToggweiler, StefanStefanToggweilerBoekstegers, PeterPeterBoekstegersSchöber, AnneAnneSchöberRück, AndreasAndreasRückGeisler, TobiasTobiasGeislerKessler, MirjamMirjamKesslerKonstandin, Mathias HMathias HKonstandinKister, TobiasTobiasKisterThiele, HolgerHolgerThieleLauten, AlexanderAlexanderLautenHausleiter, JörgJörgHausleiterLurz, PhilippPhilippLurz2025-06-252025-06-252025-06-09https://boris-portal.unibe.ch/handle/20.500.12422/212083Background Right ventricular-pulmonary artery coupling (RVPAC) predicts outcomes after transcatheter tricuspid valve edge-to-edge repair (T-TEER), but its role in patient selection remains unclear. Objectives The aim of this study was to evaluate the prognostic implications of RVPAC in a European registry of patients with tricuspid regurgitation undergoing either T-TEER or medical management. Methods Among 1,885 patients with tricuspid regurgitation (n = 585 medical, n = 1,300 T-TEER), 946 were propensity matched (1:1). RVPAC, assessed as the ratio of tricuspid annular plane systolic excursion to systolic pulmonary artery pressure was analyzed for its association with 1-year mortality. Results RVPAC was significantly associated with mortality (HR: 0.11; 95% CI: 0.04-0.29; P < 0.01), with an optimized cutoff of 0.41 mm/mm Hg. Mortality differed significantly by RVPAC in both treatment groups (log-rank P < 0.01). Across RVPAC tertiles (<0.32, 0.32-0.46, and >0.46 mm/mm Hg), tricuspid annular plane systolic excursion increased (14 mm [Q1-Q3: 12-17 mm] vs 18 mm [Q1-Q3: 15-20 mm] vs 21 mm [Q1-Q3: 18-24 mm]; P < 0.01), while systolic pulmonary artery pressure (60 mm Hg [Q1-Q3: 50-70 mm Hg] vs 45 mm Hg [Q1-Q3: 40-52 mm Hg] vs 34 mm Hg [Q1-Q3: 29-41 mm Hg]; P = 0.30) and kidney function (43 mL/min/m2 [Q1-Q3: 30-57 mL/min/m2] vs 49 mL/min/m2 [Q1-Q3: 38-67 mL/min/m2] vs 53 mL/min/m2 [Q1-Q3: 40-69 mL/min/m2]; P = 0.03) declined. Mortality was highest in the low RVPAC tertile, with no difference between treatment modalities (HR: 1.04; 95% CI: 0.68-1.61; P = 0.85). T-TEER was associated with better survival than medical management in the intermediate RVPAC tertile (HR: 0.54; 95% CI: 0.31-0.94; P = 0.03). This difference persisted but weakened in the high RVPAC tertile, with the overall most favorable outcomes (HR: 0.69; 95% CI: 0.35-1.36; P = 0.27). Conclusions Poorer RVPAC reflects higher baseline risk and mortality, regardless of treatment. T-TEER is associated with better survival across a range of RVPAC values, including those less than previously suggested thresholds.enhemodynamicsright heart failuretranscatheter tricuspid valve repairtricuspid regurgitation600 - Technology::610 - Medicine & healtharticle10.48620/887484050001010.1016/j.jcin.2025.04.033