In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure
Authors: Fauvel Charles , Dillinger Jean-Guillaume , Rossanaly Vasram Reza , Bouleti Claire , Logeart Damien , Roubille François , Meune Christophe , Ohlmann Patrick , Bonnefoy-Coudraz Eric , Albert Franck , Attou Sabir , Boukhris Marouane , Pommier Thibaut , Merat Benoit , Noirclerc Nathalie , Bouali Nabil , Aghezzaf Samy , Schurtz Guillaume , Mansencal Nicolas , Andrieu Stéphane , Henry Patrick , Pezel Théo ,   for the ADDICT-ICCU Investigators, Aboyans Victor , Albert Emeric , Albert Franck , Alvain Sean , Amri Nabil , Andrieu Stéphane , Attou Sabir , Auvray Simon , Azzakani Sonia , Azencot Ruben , Bedossa Marc , Boccara Franck , Boccara Albert , Bochaton Thomas , Bonnefoy-Cudraz Eric , Bonnet Guillaume , Bonnet Guillaume , Bouali Nabil , Bouchot Océane , Bouleti Claire , Boukertouta Tanissia , Brette Jean Baptiste , Canu Marjorie , Chaib Aures , Charbonnel Clement , Chaussade Anne Solene , Coppens Alexandre , Cottin Yves , Darmon Arthur , De Angelis Elena , Delmas Clément , Delsarte Laura , Deney Antoine , Dib Jean Claude , Dillinger Jean-Guillaume , Docq Clemence , Dupasquier Valentin , Elbaz Meyer , El Hadad Antony , El Ouahidi Amine , Ezzouhairi Nacim , Fabre Julien , Fard Damien , Fauvel Charles , Gerbaud Édouard , Gilard Martine , Goralski Marc , Grinberg Nissim , Grentzinger Alain , Hauguel-Moreau Marie , Henry Patrick , Huet Fabien , Landemaine Thomas , Lattuca Benoit , Lemarchand Léo , Levasseur Thomas , Lim Pascal , Maitre Ballesteros Laura , Mansencal Nicolas , Marie Benjamin , Martinez David , Merat Benoit , Meune Christophe , Millischer Damien , Moine Thomas , Nhan Pascal , Noirclerc Nathalie , Ohlmann Patrick , Pezel Théo , Picard Fabien , Piliero Nicolas , Pommier Thibaut , Puymirat Etienne , Ramonatxo Arthur , Rossanaly Vasram Reza , Roubille François , Roule Vincent , Schurtz Guillaume , Stevenard Mathilde , Sulman David , Swedsky Fédérico , Tea Victoria , Thevenet Eugénie , Thuaire Christophe , Trimaille Antonin , Tron Christophe , Viboud Guillaume , Yomi Dominique , Zakine Cyril 
Published: March 2024

Abstract

Aims
Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography appears to be a good non-invasive approach for right ventricular to pulmonary artery coupling assessment. We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for acute heart failure (AHF).

Methods and results
In total, 333 consecutive patients (mean age 68 ± 14 years, 70% of male, mean left ventricular ejection fraction 44 ± 16%) were hospitalized for AHF across 39 French cardiology departments, with TAPSE/sPAP measured by echocardiography within the first 24 h of hospitalization were included in this prospective study. The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 50 (15%) patients. Using receiver operating characteristic curve analysis, the best TAPSE/sPAP threshold for in-hospital MACEs was 0.40 mm/mmHg. TAPSE/sPAP &lt; 0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities [odds ratio (OR): 3.75, 95% CI (1.87–7.93), P &lt; 0.001], clinical severity [OR: 2.80, 95% CI (1.36–5.95), P = 0.006]. Using a 1:1 propensity-matched population, TAPSE/sPAP ratio &lt; 0.40 was associated with a higher rate of in-hospital MACEs [OR: 2.98, 95% CI (1.53–6.12), P = 0.002]. After adjustment, TAPSE/sPAP &lt; 0.40 showed the best improvement in model discrimination and reclassification above traditional prognostic factors (C-statistic improvement: 0.05; χ2 improvement: 14.4; likelihood-ratio test P &lt; 0.001). These results were consistent in an external validation cohort of 133 patients.

Conclusion
TAPSE/sPAP &lt; 0.40 mm/mmHg assessed by an early echocardiography during an AHF episode is independently associated with in-hospital MACEs suggesting enhanced close monitoring and strengthened heart failure-specific care in these patients.

Trial Registration
ClinicalTrials.gov Identifier: NCT05063097