In-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure
Charles Fauvel, Jean‐Guillaume Dillinger, Reza Rossanaly Vasram, Claire Bouleti, Damien Logeart, François Roubille, Christophe Meune, Patrick Ohlmann, Eric Bonnefoy-Coudraz, Franck Albert, Sabir Attou, Marouane Boukhris, Thibaut Pommier, Benoît Mérat, Nathalie Noirclerc, Nabil Bouali, Samy Aghezzaf, Guillaume Schurtz, Nicolas Mansencal, Stéphane Andrieu, Patrick Henry, Théo Pezel, for the ADDICT-ICCU Investigators, Victor Aboyans, Emeric Albert, Franck Albert, Sean Alvain, Nabil Amri, Stéphane Andrieu, Sabir Attou, Simon Auvray, Sonia Azzakani, Ruben Azencot, Marc Bédossa, Franck Boccara, Claude Boccara, Thomas Bochaton, Eric Bonnefoy‐Cudraz, Guillaume Bonnet, Guillaume Bonnet, Nabil Bouali, Océane Bouchot, Claire Bouleti, Tanissia Boukertouta, Jean Baptiste Brette, Marjorie Canu, Aurès Chaïb, C. Charbonnel, Anne Solène Chaussade, Alexandre Coppens, Yves Cottin, Arthur Darmon, Elena De Angelis, Clément Delmas, Laura Delsarte, Antoine Deney, Jean Claude Dib, Jean‐Guillaume Dillinger, Clémence 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, Benoît Lattuca, Léo Lemarchand, Thomas Levasseur, Pascal Lim, Laura Maitre Ballesteros, Nicolas Mansencal, B. De Sainte Marie, D. Rodríguez Martínez, Benoît Mérat, Christophe Meune, Damien Millischer, Thomas Moine, Pascal Nhan, Nathalie Noirclerc, Patrick Ohlmann, Théo Pezel, Fabien Picard, Nicolas Piliero, Thibaut Pommier, Étienne Puymirat, Arthur Ramonatxo, Reza Rossanaly Vasram, François Roubille, Vincent Roule
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; χ2 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.