A TAPSE/sPAP ratio < 0.4 mm/mmHg in ACS-related cardiogenic shock increased the 1-year risk of mortality, HF readmission, or non-fatal ACS (adjusted HR 1.79; 95% CI 1.08-2.97; p=0.024).
Cohort (n=134)
No
Does a TAPSE/sPAP ratio < 0.4 mm/mmHg predict adverse outcomes in patients with acute coronary syndrome-related cardiogenic shock?
An early TAPSE/sPAP ratio < 0.40 mm/mmHg is an independent predictor of 1-year adverse outcomes in patients with ACS-related cardiogenic shock, highlighting the prognostic importance of right ventricular-pulmonary artery coupling.
Effect estimate: HR 1.79 (95% CI 1.08-2.97)
Absolute Event Rate: 77.4% vs 45.8%
p-value: p=0.024
Abstract Introduction The prognosis of Acute coronary syndrome-related cardiogenic shock (ACS-CS) remains poor, especially when the systolic function of the right ventricle is impaired. However, given the high sensitivity of the RV to its afterload, the function of the RV cannot be interpreted without analysing the RV-pulmonary artery coupling (RV-PA). Purpose We analyzed the prognostic value of the ratio of tricuspid annulus systolic excursion to pulmonary artery systolic pressure (TAPSE/sPAP) in patients with ACS-CS, since it is a good non-invasive assessment of RV-PA coupling. Methods We reviewed the medical data of patients admitted to our CICU over a 4-year period for ACS.We excluded patients without cardiogenic shock. We defined ACS-CS according to the SCAI (Society for Cardiovascular Angiography 0.001) (Figure 1). The primary outcome was observed in 81(60.4%) patients, with 33 (45,8%) patient with TAPSE/sPAPS0,4 and 48 (77,4%) patient with TAPSE/sPAPS0,4 (Hazard ratio at 2.07 (95%CI; 1.33-3.20; p=0.001) before adjustment) The kaplein-meier survival analysis showed a significant difference between the patient of the principal endpoint according the TAPSE/sPAPS ratio with log-Rank test pValue at 0,002 (Figure 2).The result was still statistically significant after adjustment for ejection fraction, creatinine level and myocardial revascularisation (hazard ratio of 1.79 (95%CI; 1.08-2.97; p=0.024). Conclusion A TAPSE/sPAP ratio 0.40 mm/mmHg assessed by early echocardiography during ACS-CS is independently associated with prognosis at 1 year, suggesting the important involvement of RV-PA coupling in the severity of cardiogenic shock.FIGURE 1 FIGURE 2
Bouchlarhem et al. (Sat,) conducted a cohort in Acute coronary syndrome-related cardiogenic shock (n=134). TAPSE/sPAP ratio < 0.4 mm/mmHg vs. TAPSE/sPAP ratio > 0.4 mm/mmHg was evaluated on Composite of all-cause mortality, readmission for heart failure or non-fatal ACS at 1 year (HR 1.79, 95% CI 1.08-2.97, p=0.024). A TAPSE/sPAP ratio < 0.4 mm/mmHg in ACS-related cardiogenic shock increased the 1-year risk of mortality, HF readmission, or non-fatal ACS (adjusted HR 1.79; 95% CI 1.08-2.97; p=0.024).