Prognostic role of right ventricular-pulmonary arterial coupling in acute myocardial infarction

Abstract Background The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is an indicator of right ventricular-pulmonary arterial (RV-PA) coupling and has been found to be a remarkable prognostic factor in patients with heart failure. Its prognostic significance in acute myocardial infarction (AMI), where acute right ventricular pressure overload can occur, remains poorly explored. Objective To investigate the prognostic value of RV-PA coupling, measured by TAPSE/PASP ratio, in patients with AMI. Methods Consecutive patients with AMI were enrolled from January 2017 to January 2024. AMI was defined according to the Fourth Universal Definition of Myocardial Infarction. Patients underwent transthoracic echocardiography within 24 hours of admission to the intensive care unit. RV-PA coupling was assessed using the TAPSE/PASP ratio. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal TAPSE/PASP cutoff for predicting in-hospital mortality. Multivariable Cox proportional hazards regression model was constructed to evaluate the independent prognostic role of TAPSE/PASP in predicting one-year mortality. Results TAPSE/PASP measurements were available for 1157 patients, with a mean value of 0.77 ± 0.31 mm/mmHg. Patients with in-hospital mortality exhibited a significantly lower TAPSE/PASP ratio (p 0.001). Using ROC analysis, the TAPSE/PASP ratio demonstrated an area under the curve (AUC) of 0.794 for predicting in-hospital mortality. Based on Youden’s index, the optimal cutoff value was identified as 0.46 mm/mmHg. During the one-year follow-up, 65 deaths were recorded. Kaplan-Meier survival curves comparing patients with low TAPSE/PASP (0.46 mm/mmHg) and high TAPSE/PASP (≥0.46 mm/mmHg) showed that a lower TAPSE/PASP was significantly associated with worse prognosis (p0.001). In multivariable Cox regression analysis, TAPSE/PASP 0.46 was independently associated with 1-year mortality (HR 2.2, 95% CI 1.3–3.9, p=0.004), along with lower left ventricular ejection fraction (p=0.05), lower hemoglobin levels (p=0.003), higher creatinine levels (p=0.04), and older age (p0.001). Conclusion In patients with AMI, RV-PA uncoupling, defined by a TAPSE/PASP ratio 0.46, is associated with higher in-hospital mortality and increased all-cause mortality at 1 year. These findings highlight the added prognostic value of this parameter, as it not only reflects RV function but also takes into account its afterload, providing a more comprehensive assessment of RV performance.ROC curve for TAPSE/PASP ratio Kaplan-Meier curves