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

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