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- Title
In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure.
- Authors
Fauvel, Charles; Dillinger, Jean-Guillaume; Vasram, Reza Rossanaly; 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
- 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 < 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 < 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 < 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 < 0.40 showed the best improvement in model discrimination and reclassification above traditional prognostic factors (C-statistic improvement: 0.05; χ 2 improvement: 14.4; likelihood-ratio test P < 0.001). These results were consistent in an external validation cohort of 133 patients. Conclusion TAPSE/sPAP < 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
- Subjects
TRICUSPID valve; LEFT heart ventricle; CARDIOGENIC shock; VENTRICULAR ejection fraction; RECEIVER operating characteristic curves; GRAPHIC arts; T-test (Statistics); PULMONARY artery; MAJOR adverse cardiovascular events; FISHER exact test; HEART failure; HEART physiology; CHI-squared test; MANN Whitney U Test; DESCRIPTIVE statistics; LONGITUDINAL method; ODDS ratio; SYSTOLIC blood pressure; RIGHT ventricular dysfunction; CARDIAC arrest; CONFIDENCE intervals; ECHOCARDIOGRAPHY; COMORBIDITY
- Publication
European Heart Journal - Cardiovascular Imaging, 2024, Vol 25, Issue 8, p1099
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeae059