Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of outcome in acute heart failure

Abstract

Introduction

Acute heart failure (AHF) is a life-threatening condition that requires swift diagnosis and tailored management to enhance patient outcomes. In the pursuit of more precise prognostic indicators, Tricuspid Annular Plane Systolic Excursion (TAPSE) and Pulmonary Arterial Systolic Pressure (PASP) have emerged as potential significant advancements. The TAPSE/PASP ratio, a novel parameter, has recently gained attention as a promising predictor of outcomes in acute heart failure.

Objective

The present study aims to establish the predictive value of the TAPSE/PASP ratio in determining all-cause mortality and/or rehospitalization in patients dealing with AHF.

Method

This was a prospective, monocentric, observational study, conducted from December 2020 to December 2022 in the Cardiology Department of our hospital. We included patients hospitalized for a diagnosis of AHF. Echocardiographic evaluation was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PASP, TAPSE/PASP ratio).

Results

The study cohort included 152 consecutive patients. Mean follow up was 18 ± 6 months. Mean age was 65 years, and the majority (70%) were men. Ischemic heart disease was the leading cause of heart failure, accounting for 50% of all cases. The mean left ventricular ejection fraction was 38%. During follow-up, 69 patients died or were hospitalized for AHF (45%), 29 patients died (19%)within an average period of 3.7 months and 57 patients were hospitalized for AHF (37%). The TAPSE/PASP ratio emerged as a significant independent predictor of clinical outcomes in AHF patients (HR = 2.601;95% CI: 1.044–6.477; P = 0.040). Furthermore, among the echocardiographic parameters assessed, the TAPSE/PASP ratio was the sole predictor of rehospitalization for AHF (HR = 3.975; 95% CI: 1.386–11.401; P = 0.010). It also independently predicted all-cause mortality in AHF, with an HR of 2.735(; 95% CI: 1.250–9.124; P = 0.031). When evaluating its predictive accuracy, the TAPSE/PASP ratio with a cutoff value < 0.35 mm/mmHg demonstrated a sensitivity of 65%, specificity of 70%, and an area under the receiver operating characteristic (ROC) curve of 0.701 for forecasting adverse outcomes.

Conclusion

The non-invasive TAPSE/PASP ratio is an independent predictor of mortality and/or rehospitalization in patients with AHF.