In-hospital Prognostic Value of TAPSE/sPAP in Patients Hospitalized for Acute Heart Failure

Abstract Background Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography appears to be a good noninvasive approach for right ventricular to pulmonary artery coupling assessment. Yet, the in-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure (AHF) has never been explored. Purpose To assess TAPSE/sPAP prognostic value among patients hospitalized for AHF. Methods All consecutive major patients hospitalized for AHF across 39 French cardiology department, with TAPSE/sPAP measured by echocardiography within the 24 first hours of hospitalization were included in this prospective study. The primary outcome was in-hospital major cardiac adverse events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock. Results Three hundred and thirty-three patients with both AHF and TAPSE/sPAP measurement were included (mean age 68±14 years, 70% of male, 40% HFpEF, 18% HFmrEF, 42% HFrEF). In-hospital MACEs occurred in 50 (15%) of the patients. Using receiver operating characteristics curves analysis, the best threshold for in-hospital MACEs was 0.40 mm/mmHg. Patients with TAPSE/sPAP <0.40 mm/mmHg had more frequently atrial fibrillation (p=0.024), chronic kidney disease (p=0.001), higher NTproBNP level (p<0.001), and worse left and right ventricular function (p<0.01). TAPSE/sPAP <0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities (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), or using a propensity matched population analysis (OR=2.98, 95%CI[1.53-6.12], p=0.002, figure 1). Finally, TAPSE/sPAP showed incremental prognostic value for in-hospital MACEs over traditional risk factors, including left ventricular ejection fraction (figure 2). Conclusion Emphasizing the prognostic value of TAPSE/sPAP <0.40 mm/mmHg for in-hospital MACEs, over traditional risk factors, these results suggest embedding this parameter into clinical decision-making and risk stratification in patients hospitalized for AHF.