{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T12:22:02Z","timestamp":1784290922044,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Right ventricular\u2013pulmonary arterial (RV\u2013PA) uncoupling in cardiac amyloidosis (CA) has been underexplored, with focus mainly on tricuspid annular plane systolic excursion (TAPSE)\/pulmonary artery systolic pressure (PASP). This study aims to evaluate the association of various echocardiographic surrogates of RV\u2013PA coupling with outcomes in cardiac transthyretin (ATTR-CA) and light-chain (AL-CA) amyloidosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed RV\u2013PA coupling in patients diagnosed with ATTR-CA and AL-CA at our center between 2014 and 2023. RV\u2013PA coupling was assessed using TAPSE\/PASP, fractional area change (FAC)\/PASP, and RV free wall strain (RVFWS)\/PASP. The primary endpoint was all-cause mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 120 patients (86% ATTR-CA, 14% AL-CA) were included in the study (median age 77 years, 88% male). During a median follow-up period of 23 (IQR: 15\u201334) months, the primary endpoint occurred in 25 patients (21%). The study population was stratified based on the ROC-derived TAPSE\/PASP cutoff of &amp;lt;0.30\u2005mm\/mmHg, demonstrating RV\u2013PA uncoupling. Lower RV\u2013PA coupling surrogates were independently associated with higher mortality (HR per +0.1 unit: TAPSE\/PASP, 0.74, 95% CI: 0.59\u20130.93, <jats:italic>p<\/jats:italic>\u2009=\u20090.011; FAC\/PASP, 0.87, 0.77\u20130.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.018; RVFWS\/PASP, 0.78, 0.63\u20130.97, <jats:italic>p<\/jats:italic>\u2009=\u20090.024). TAPSE\/PASP demonstrated the strongest prognostic discrimination (AUC: 0.79, bootstrapped 95% CI: 0.66\u20130.91), compared with FAC\/PASP (AUC: 0.75, 0.58\u20130.91) and RVFWS\/PASP (AUC: 0.72, 0.52\u20130.87).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>RV\u2013PA uncoupling may be linked to a higher risk of all-cause mortality in CA. TAPSE\/PASP outperformed numerically FAC\/PASP and RVFWS\/PASP in predicting long-term survival, although it did not clearly outperform established RV function parameters.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1653950","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T05:26:17Z","timestamp":1759123577000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prognostic implications of right ventricular to pulmonary artery uncoupling in cardiac amyloidosis"],"prefix":"10.3389","volume":"12","author":[{"given":"Aiste 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