Transcatheter aortic valve replacement (TAVR) stands as a well-established treatment for patients with severe aortic stenosis (AS). As its application broadens, TAVR is now increasingly used for patients ranging from high surgical risk to moderate surgical risk and even extending to low surgical risk, as evidenced by numerous randomized clinical trials.1, 2, 3, 4 Consistently, the clinical outcomes remain variable, significantly influenced by the range of surgical risk, duration of follow-up, and end point events.5, 6, 7, 8 In patients with symptomatic severe AS, cardiac damage often begins even before the development of overt symptoms and is associated with adverse clinical outcomes after TAVR. Among them, pulmonary hypertension and right ventricular (RV) dysfunction are well-known critical indicators of adverse clinical outcomes in patients after TAVR.9 Indeed, given the convenient noninvasive nature and the strong correlation between RV performance and its afterload, gaining a deeper understanding of RV-pulmonary artery coupling (RV-PA coupling) and its profound impact on clinical outcomes has become a priority. Previous studies demonstrated that the ratio of tricuspid annular plane systolic excursion to PA systolic pressure (TAPSE/PASP) was usually used as an indicator of RV-PA coupling in patients with acute heart failure,10,11 with AS,12 and post-TAVR.13,14

Recently, the assessment of RV myocardial deformation by speckle-tracking (specifically, RV free wall longitudinal strain [RVFWLS] and its ratio to estimated PASP [RVFWLS/PASP ratio]) has emerged as an angle-independent and reliable echocardiographic method, and this technique provides valuable prognostic implications in heart failure with preserved ejection fraction.15 Strain imaging for evaluating myocardial deformation provides prognostic information beyond traditional echocardiographic parameters.16 Consequently, the RVFWLS/PASP ratio may provide better prognostic value in the post-TAVR population, although evidence remains limited. Therefore, in the current study, we aimed to evaluate the prognostic impact of this novel RV-PA uncoupling in a large cohort of post-TAVR patients.