Right ventricular-pulmonary artery uncoupling predicts negative outcome after TIPS implantation: a pilot study

Background and aims Recently, reduced right ventricular (RV) contractility has been shown to be associated with TIPS-refractory ascites. Reduced RV contractility may also lead to right ventricular–pulmonary artery (RV-PA) uncoupling that occurs when the right ventricle's contractility fails to match the increased afterload imposed by the pulmonary arteries. As TIPS implantation leads to a sudden inrease in pulmonary artery systolic pressure (PASP), RV-PA uncoupling may be of prognostic relevance in these patients. Methods 110 patients with TIPS implantation and detailed echocardiographic assessment were included in this retrospective study (NCT05782556). RV-PA uncoupling was analysed by assessing right ventricular free wall strain (RV strain) divided by PASP (RV/PASP). RV-Strain/PASP