Right ventricular–pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool

The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular–pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocar...

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Bibliographic Details
Published in:Hellenic journal of cardiology 2024-07
Main Authors: Anastasiou, Vasileios, Daios, Stylianos, Moysidis, Dimitrios V., Liatsos, Alexandros C., Papazoglou, Andreas S., Didagelos, Matthaios, Savopoulos, Christos, Bax, Jeroen J., Ziakas, Antonios, Kamperidis, Vasileios
Format: Article
Language:English
Subjects:
Acute myocardial infarction
Echocardiography
Mortality
Right ventricular–pulmonary artery coupling
Risk stratification
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Summary:The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular–pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored. This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03–0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ2 26.55) was significantly improved by adding LVEF ≤40% (χ2 44.71, P 
ISSN:1109-9666
2241-5955
2241-5955
DOI:10.1016/j.hjc.2024.07.002