ObjectiveTo investigate the prognostic value of the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) for all-cause mortality after left ventricular assist device (LVAD) implantation, and to provide evidence for optimizing preoperative risk stratification and perioperative management in LVAD patients. MethodsClinical data were retrospectively collected from patients undergoing LVAD implantation at Zhengzhou 7th People's Hospital between April 21, 2021, and August 24, 2025. The optimal cutoff value of TAPSE/PASP was determined using receiver operating characteristic (ROC) curve analysis, and patients were grouped accordingly. Kaplan-Meier curves were used to compare postoperative cumulative survival rates between groups. Multivariate Cox proportional hazards regression models were applied to identify independent predictors of all-cause mortality. ResultsA total of 61 patients were enrolled, including 44 males and 17 females with a median age of 56 (42, 60) years. Patients were divided into a group A (TAPSE/PASP<0.396, n=43) and a group B (TAPSE/PASP≥0.396, n=18) based on the optimal cutoff value of 0.396. Group A exhibited higher median right ventricular fractional area change (40% vs. 33%, P<0.001), ratio of right ventricular fractional area change to PASP (1.214 vs. 0.615, P<0.001), and preoperative left ventricular end-diastolic diameter (77 mm vs. 69 mm, P=0.006). Conversely, group A showed lower TAPSE/PASP ratio (0.333 vs. 0.508, P<0.001), PASP (34 mm Hg vs. 52 mm Hg, P<0.001), diastolic pulmonary artery pressure (13 mm Hg vs. 29 mm Hg, P<0.001), mean pulmonary artery pressure (21 mm Hg vs. 34 mm Hg, P=0.001), and preoperative central venous pressure (5.5 mm Hg vs. 11.0 mm Hg, P=0.002). Additionally, group A had higher incidence of tricuspid valve repair/replacement (55.8% vs. 27.8%, P=0.046) and shorter median survival time (96 days vs. 212 days, P=0.007). Median follow-up duration was 157 (56, 227) days. Log-rank analysis demonstrated significantly lower survival rate in the group A compared to group B (P=0.009). Multivariate Cox regression analysis identified TAPSE/PASP as an independent predictor for all-cause mortality after LVAD implantation [HR=0.001, 95%CI (0.001, 0.003), P=0.005]. The ROC curve demonstrated an area under the curve of 0.740 for TAPSE/PASP in predicting postoperative all-cause mortality. ConclusionTAPSE/PASP effectively evaluates right ventricular-pulmonary artery coupling status and serves as an independent prognostic factor for all-cause mortality following LVAD implantation. This parameter provides important guidance for preoperative risk assessment and perioperative management in LVAD candidates.