TAPSE-to-tricuspid regurgitant pressure gradient ratio and early mortality in hospitalized heart failure

Q: What are the key findings of this study?

A 1-SD lower TAPSE-to-TRPG ratio was associated with increased in-hospital mortality (OR 1.45) in hospitalized heart failure patients, but did not outperform its individual components.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hospitalized heart failure (n=2356). Intervention: TAPSE-to-TRPG ratio (per 1-SD lower) vs. Higher TAPSE-to-TRPG ratio. Primary outcome: In-hospital death (OR 1.45, 95% CI 1.19-1.76, p=<0.001).

Q: What does this research mean for the field?

A lower TAPSE-to-TRPG ratio is associated with increased early mortality in hospitalized heart failure patients but does not provide incremental prognostic value over its individual components. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether the echocardiographic TAPSE-to-TRPG ratio predicts early mortality in hospitalized heart failure and provides incremental prognostic value beyond its individual components.

Isabelle Moseley; Akhil Vaid

doi:10.1016/j.ahjo.2026.100876

August 28, 2026American Heart Journal Plus Cardiology Research and PracticeOpen Access

TAPSE-to-tricuspid regurgitant pressure gradient ratio and early mortality in hospitalized heart failure

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Key result

Lower TAPSE-to-TRPG ratio is linked to ~45% higher in-hospital HF mortality per SD.

OR 1.45
95% CI 1.19-1.76
P<0.001
n=2,356

Figures

Why the study?

The TAPSE-to-TRPG ratio may summarize right-ventricular function relative to Doppler pressure load, but selective measurement and significant tricuspid regurgitation may limit its value.

Does a lower TAPSE-to-TRPG ratio predict early mortality in hospitalized heart failure patients?

Key Points

To determine whether the echocardiographic TAPSE-to-TRPG ratio predicts early mortality in hospitalized heart failure and provides incremental prognostic value beyond its individual components.
Retrospective cohort analysis of linked MIMIC-IV and MIMIC-IV-ECHO data evaluated 16,240 eligible first heart failure admissions with early echocardiography, yielding a complete-case cohort of N=2356 with TAPSE, TRPG, and numeric LVEF.
Primary outcomes were in-hospital and 30-day mortality, assessed using multivariable logistic regression, inverse-probability weighting, multiple imputation, landmark analyses, and competing-discharge models.
Model performance and incremental discrimination were assessed via cross-validated AUC, Brier score, and calibration slope, alongside subgroup analyses stratified by tricuspid regurgitation severity and cardiac index.
Lower TAPSE-to-TRPG ratio was associated with increased in-hospital mortality (adjusted OR 1.45 per 1-SD decrease, 95% CI 1.19–1.76, P < 0.001) and 30-day mortality (adjusted OR 1.55, 95% CI 1.30–1.85, P < 0.001).
The ratio did not outperform individual metrics; cross-validated AUC for in-hospital mortality was 0.673 for the ratio versus 0.686 for TAPSE alone, and for 30-day mortality was 0.684 versus 0.699 for TAPSE alone.
The in-hospital association was present without moderate-or-greater tricuspid regurgitation (OR 1.51) but was not statistically evident in patients with moderate-or-greater tricuspid regurgitation (OR 1.02; interaction P=0.052).

Study Design

Type

Cohort (n=2,356)

Multicenter

No

Structured PICO

Does a lower TAPSE-to-TRPG ratio predict early mortality in hospitalized heart failure patients?

P

Population

2,356 adults hospitalized with heart failure who underwent early echocardiography, evaluated for in-hospital and 30-day mortality.

E

Exposure

TAPSE-to-TRPG ratio (evaluated continuously per 1-SD lower ratio and by quartiles)

O

Outcome

In-hospital death after the exposure indexhard clinical

Main Result

Odds Ratio: 1.45 (95% CI 1.19–1.76)

p-value: p=<0.001

While a lower TAPSE-to-TRPG ratio identifies higher early mortality in hospitalized heart failure patients, it does not statistically outperform its individual echo components, remaining primarily a hypothesis-generating marker.

Limitations

Single-center retrospective data
Selective echo measurement with severe missing-not-at-random bias (81% of TAPSE values absent)
Residual and unmeasured confounding
Possible treatment-related alteration of TRPG within the 72-hour echo window
Absence of invasive hemodynamics, explicit right atrial pressure, and adjudicated heart-failure etiology
single-center retrospective data
selective echo measurement
residual and unmeasured confounding
possible treatment-related alteration of TRPG within the 72-hour echo window
absence of invasive hemodynamics, explicit right atrial pressure, adjudicated heart-failure etiology, and multiorgan ultrasound
missing-not-at-random bias when approximately 81% of TAPSE values are absent

Implication

May support early risk assessment in hospitalized HF but should not yet change practice; leaves open incremental value over TAPSE or TRPG alone.

Abstract

Background: The TAPSE-to-TRPG ratio may summarize right-ventricular function relative to Doppler pressure load, but selective measurement and significant tricuspid regurgitation (TR) may limit its value. Methods: In linked MIMIC-IV and MIMIC-IV-ECHO data, we studied first heart-failure admissions with early echocardiography. Complete-case, inverse-probability-weighted, and multiply imputed models evaluated in-hospital and 30-day mortality; incremental performance, TR, cardiac index, timing, and competing discharge were examined. Results: Of 16,240 eligible patients, 2356 had TAPSE, TRPG, and numeric LVEF. Lower ratio was associated with in-hospital (OR 1.45, 95% CI 1.19-1.76) and 30-day mortality (OR 1.55, 95% CI 1.30-1.85), with consistent sensitivity estimates. TAPSE alone and separate-component models had greater cross-validated discrimination. The in-hospital association was not statistically evident in moderate-or-greater TR. Conclusions: Lower ratio identified higher early mortality but did not outperform its components; it remains hypothesis-generating rather than a validated incremental metric.

Discussion

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Cite This Study

Moseley et al. (2026) conducted a cohort in Hospitalized heart failure (n=2,356). TAPSE-to-TRPG ratio (per 1-SD lower) vs. Higher TAPSE-to-TRPG ratio was evaluated on In-hospital death (OR 1.45, 95% CI 1.19-1.76, p=<0.001). A 1-SD lower TAPSE-to-TRPG ratio was associated with increased in-hospital mortality (OR 1.45) in hospitalized heart failure patients, but did not outperform its individual components.

synapsesocial.com/papers/6ad0fcc53afa093ea9acffff https://doi.org/10.1016/j.ahjo.2026.100876

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TAPSE-to-tricuspid regurgitant pressure gradient ratio and early mortality in hospitalized heart failure

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

TAPSE-to-tricuspid regurgitant pressure gradient ratio and early mortality in hospitalized heart failure

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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