Prognostic value of TAPSE/RVSP ratio in patients with acute heart failure: a prospective observational cohort study

Background/Introduction

The tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) ratio, derived from echocardiography, has been proposed as a valid, non-invasive surrogate of the right ventricle-pulmonary artery coupling in heart failure (HF), demonstrating strong prognostic utilities in stable patients with chronic HF and preserved or reduced ejection fraction (EF). However, there are scarce data in patients with acute HF.

Purpose

The aim of the current study was to investigate the prognostic role of the TAPSE/RVSP ratio in adult patients hospitalised for acute HF in our Cardiology department.

Methods

This was a prospective observational cohort study of consecutive adult individuals who experienced an acute de novo HF event or had acute decompensated HF between August 2023 and June 2024. An independent investigator conducted a comprehensive transthoracic echocardiogram within the first 24 hours since admission and each patient was classified as having HF with reduced, mildly reduced or preserved EF according to the ESC guidelines. Moreover, the TAPSE/RVSP ratio was calculated according to the EACVI guidelines. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome and each patient was followed until the 20th of June or until the composite outcome occurred. TAPSE/RVSP ratio was divided in tertiles (≤0.30, 0.31-0.40, >0.40). Kaplan-Meier curves as well as univariate and multivariable cox regression analyses were used for data analysis and presentation.

Results

In total, 143 patients with acute HF (mean age 82 years, 58% female) were included in the study. Of those, 36% were diagnosed as having acute de novo HF. Half of total patients were classified as HF with preserved EF. Mean right ventricular diameter was 40 ± 8 mm and mean TAPSE was 15.4 ± 3.7 mm. During a median follow-up of 123 days, the composite outcome occurred in 36% of patients (n=52). By Kaplan-Meier analysis, individuals in the lowest tertile (TASPE/RVSP ratio ≤0.30) showed the lowest freedom from the composite outcome (Figure 1; p <0.0001, log-rank test). In multivariable regression analysis, TAPSE/RVSP ratio ≤0.30 was associated with a 14-fold risk of all-cause mortality or HF re-hospitalisation (Figure 2; adjusted hazard ratio: 14.7; 95% CI: 2.5, 85.3; p=0.002).

Conclusions

In patients hospitalised for acute HF, a statistically significant association between the TAPSE/RVSP ratio and the composite outcome was found. Those patients with TAPSE/RVSP ratio ≤0.30 had a 14-fold risk of all-cause mortality or HF re-hospitalisation.

Kaplan-Meier curves

Multivariable Cox regression analysis