Key result
In patients with acute coronary syndrome, a TAPSE/PASP ratio < 0.55 was not independently associated with in-hospital major adverse cardiovascular events in multivariate analysis (OR 1.150).
Why the study?
An impaired TAPSE/PASP ratio is linked to poor prognosis under elevated RV afterload, but its prognostic role in ACS remains unclear.
Does right ventricular-pulmonary artery uncoupling (TAPSE/PASP < 0.55) predict in-hospital major adverse cardiovascular events in patients with acute coronary syndrome?
Observational (n=152)
No
Does right ventricular-pulmonary artery uncoupling (TAPSE/PASP < 0.55) predict in-hospital major adverse cardiovascular events in patients with acute coronary syndrome?
In patients with acute coronary syndrome, right ventricular-pulmonary artery uncoupling (TAPSE/PASP < 0.55) is associated with in-hospital MACE and prolonged stay, but this association is driven by other factors like reduced LVEF and high GRACE score rather than being an independent predictor.
INTRODUCTION: Right ventricular-pulmonary artery (RV-PA) coupling evaluates the relationship between right ventricular contractility and afterload. It is normal when both are well-matched. A reduction in RV contractility or an increase in RV afterload leads to RV-PA uncoupling, decreasing left ventricular filling, stroke volume, and causing peripheral hypoperfusion and congestion. The TAPSE/PASP ratio is a reliable non-invasive method to assess this coupling. An impaired TAPSE/PASP ratio is associated with poor prognosis in conditions of elevated RV afterload, but its role in acute coronary syndrome (ACS) is unclear. AIM: The aim of this study is to investigate the in-hospital prognostic value of the TAPSE/PASP ratio and the predictors of a low TAPSE/PASP ratio. METHODS: This retrospective, pilot study included 152 patients admitted for ACS (77.6% STEMI, 22.4% NSTEMI) between November 2023 and March 2025, with available TAPSE/PASP data from echocardiography performed at admission. The primary objective was to assess whether the TAPSE/PASP ratio predicts in-hospital major adverse cardiovascular events (MACE). Secondary objectives included evaluating whether TAPSE/PASP predicts in-hospital ventricular arrhythmias, intraventricular thrombosis, prolonged hospital stay, and identifying predictors of a low TAPSE/PASP ratio. RESULTS: TAPSE/PASP < 0.55 was significantly associated with MACE and prolonged hospital stay in univariate analysis, but not in multivariate analysis. TAPSE/PASP < 0.55 was largely explained by E/e' >14 (OR 6.600; p = 0.0008), RV involvement (OR 9.430; p = 0.0007), and age >75 years (OR 3.243; p = 0.0389). CONCLUSIONS: Low RV-PA coupling (TAPSE/PASP < 0.55) is associated with MACE and prolonged hospital stay in ACS, but lacks independent prognostic value in multivariate analysis.
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Piras et al. (2025) conducted an observational in Acute Coronary Syndrome (n=152). TAPSE/PASP ratio < 0.55 vs. TAPSE/PASP ratio ≥ 0.55 was evaluated on In-hospital major adverse cardiovascular events (MACE) (OR 1.150, 95% CI 0.2763-4.604, p=0.8842). In patients with acute coronary syndrome, a TAPSE/PASP ratio < 0.55 was not independently associated with in-hospital major adverse cardiovascular events in multivariate analysis (OR 1.150).
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