SPC365

Prognostic Value of Right ventricular to Pulmonary Artery Coupling in Transthyretin Amyloid Cardiomyopathy

Session: Sessão de Posters 52 - Função auricular, interação ventricular e fenotipagem miocárdica
Speaker: Bárbara Lage Garcia

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Bárbara Lage Garcia; Emídio Mata; Luísa Pinheiro; Margarida de Castro; Tamara Pereira; Filipa Cordeiro; Marina Fernandes; Lucy Calvo; Olga Azevedo; António Lourenço

<p>Introduction:&nbsp;Right ventricular&ndash;pulmonary artery (RV-PA)&nbsp;uncoupling has emerged as an important prognostic marker in several cardiopulmonary diseases, but its relevance in Transthyretin Amyloid Cardiomyopathy (ATTR-CM) remains underexplored.&nbsp;</p>

<p>Aim:&nbsp;To&nbsp;determine whether RV-PA coupling indices&nbsp;-&nbsp;TAPSE/PASP&nbsp;(Tricuspid Annular Plane Systolic Excursion/Pulmonary Artery Systolic Pressure), FAC/PASP&nbsp;(Fractional Area Change), and RVGLS/PASP&nbsp;(Right Ventricular&nbsp;Global&nbsp;Longitudinal&nbsp;Strain)&nbsp;-&nbsp;predict a composite outcome of all-cause mortality and heart failure hospitalization&nbsp;(HFH)&nbsp;in patients with ATTR-CM.&nbsp;</p>

<p>Methods:&nbsp;We conducted a retrospective observational study including patients with confirmed ATTR-CM who underwent transthoracic echocardiography. RV-PA coupling was&nbsp;evaluated&nbsp;using TAPSE/PASP, FAC/PASP, and RVGLS/PASP. Non-coupled RV parameters were also&nbsp;assessed. Clinical follow-up included the composite of all-cause mortality and HFH. Cox proportional hazards models were used to identify independent predictors. Prognostic performance was&nbsp;estimated&nbsp;with ROC curve analysis. Kaplan-Meier survival curves were constructed using the optimal ROC-derived cut-off values, and differences were evaluated using the log-rank test.&nbsp;</p>

<p>Results:&nbsp;A total of 52 patients were included (mean age 82 years, 69% male). Among the parameters evaluated, FAC/PASP (HR 0.42&nbsp;[0.17-0.998]&nbsp;p=0.049) and FAC (HR 0.97&nbsp;[0.93-0.997]&nbsp;p=0.037) were the only independent predictors of the composite outcome. TAPSE/PASP (HR 0.19&nbsp;[0.03-1.35]&nbsp;p=0.096), RVGLS/PASP (HR 0.15&nbsp;[0.02-1.43]&nbsp;p=0.098), TAPSE (HR 0.94&nbsp;[0.87-1.02]&nbsp;p=0.139), and RVGLS (HR 0.94&nbsp;[0.88-1.02]p=0.139) were not statistically significant.&nbsp;</p>

<p>At 1-year follow-up, ROC analysis showed: FAC/PASP&nbsp;area under the curve (AUC) of&nbsp;0.654 [0.508-0.782], TAPSE/PASP AUC&nbsp;of&nbsp;0.592 [0.447-0.726], and RVGLS/PASP AUC&nbsp;of&nbsp;0.569 [0.424-0.706]. The optimal FAC/PASP cut-off was &le;0.6, with&nbsp;sensitivity of&nbsp;39% and&nbsp;a specificity of&nbsp;92%. Stratification using the ROC-derived FAC/PASP threshold of 0.6 %/mmHg identified patients with RV-PA uncoupling. Kaplan-Meier analysis demonstrated significantly higher event rates in patients below this threshold, confirmed by the log-rank test (p = 0.0002).&nbsp;</p>

<p>Conclusion:&nbsp;In patients with cardiac amyloidosis, RV-PA uncoupling&nbsp;(particularly FAC/PASP)&nbsp;may&nbsp;be associated with adverse outcomes. More robust studies are needed to confirm FAC/PASP&nbsp;as a potential marker for risk stratification and help guide clinical decision-making in this population.&nbsp;</p>

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