In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure

• Published in: European heart journal cardiovascular imaging 2024-07, Vol.25 (8), p.1099-1108
• Main Authors: Fauvel, Charles, Dillinger, Jean-Guillaume, Rossanaly Vasram, Reza, Bouleti, Claire, Logeart, Damien, Roubille, François, Meune, Christophe, Ohlmann, Patrick, Bonnefoy-Coudraz, Eric, Albert, Franck, Attou, Sabir, Boukhris, Marouane, Pommier, Thibaut, Merat, Benoit, Noirclerc, Nathalie, Bouali, Nabil, Aghezzaf, Samy, Schurtz, Guillaume, Mansencal, Nicolas, Andrieu, Stéphane, Henry, Patrick, Pezel, Théo
• Format: Article
• Language: English
• Subjects: Life Sciences
• ISSN: 2047-2404; 2047-2412; 2047-2412
• DOI: 10.1093/ehjci/jeae059

Abstract Aims Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography appears to be a good non-invasive approach for right ventricular to pulmonary artery coupling assessment. We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for acute heart failure (AHF). Methods and results In total, 333 consecutive patients (mean age 68 ± 14 years, 70% of male, mean left ventricular ejection fraction 44 ± 16%) were hospitalized for AHF across 39 French cardiology departments, with TAPSE/sPAP measured by echocardiography within the first 24 h of hospitalization were included in this prospective study. The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 50 (15%) patients. Using receiver operating characteristic curve analysis, the best TAPSE/sPAP threshold for in-hospital MACEs was 0.40 mm/mmHg. TAPSE/sPAP < 0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities [odds ratio (OR): 3.75, 95% CI (1.87–7.93), P < 0.001], clinical severity [OR: 2.80, 95% CI (1.36–5.95), P = 0.006]. Using a 1:1 propensity-matched population, TAPSE/sPAP ratio < 0.40 was associated with a higher rate of in-hospital MACEs [OR: 2.98, 95% CI (1.53–6.12), P = 0.002]. After adjustment, TAPSE/sPAP < 0.40 showed the best improvement in model discrimination and reclassification above traditional prognostic factors (C-statistic improvement: 0.05; χ2 improvement: 14.4; likelihood-ratio test P < 0.001). These results were consistent in an external validation cohort of 133 patients. Conclusion TAPSE/sPAP < 0.40 mm/mmHg assessed by an early echocardiography during an AHF episode is independently associated with in-hospital MACEs suggesting enhanced close monitoring and strengthened heart failure-specific care in these patients. Trial Registration ClinicalTrials.gov Identifier: NCT05063097 Graphical Abstract Graphical Abstract In-hospital prognostic value of RV–PA coupling assessed by echocardiography in patients hospitalized for AHF. TAPSE/sPAP is a non-invasive parameter to RV–PA coupling assessment. In patients hospitalized for AHF, TAPSE/sPAP < 0.40 mm/mmHg assessed during the first 24 h of hospitalization was independently associated and incremental prognostic value over and above traditional risk factors for AHF. Ees/Ea, ri