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

Abstract

Aims
Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study.

Methods and results
A total of 481 consecutive patients hospitalized in intensive cardiac care unit [mean age 65 ± 13 years, 73% of male, 46% ST-elevation myocardial infarction (STEMI)] for ACS [either STEMI or non-STEMI (NSTEMI)] with TAPSE/sPAP available were included in this prospective French multicentric study (39 centres). 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 33 (7%) patients. Receiver operating characteristic curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP &lt;0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities [odds ratio (OR): 19.1, 95% confidence interval (CI) 7.78–54.8], clinical severity including left ventricular ejection fraction (OR: 14.4, 95% CI 5.70–41.7), and propensity-matched population analysis (OR: 22.8, 95% CI 7.83–97.2, all P &lt; 0.001). After adjustment, TAPSE/sPAP &lt;0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global χ2 improvement: 52.8; likelihood ratio test P &lt; 0.001) with similar results for both STEMI and NSTEMI subgroups.

Conclusion
A low RV-PA coupling defined as TAPSE/sPAP ratio &lt;0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS.

Trial Registration
ClinicalTrials.gov Identifier: NCT05063097