TAPSE/sPAP ratio predicts 1-Year mortality in cardiac resynchronization therapy recipients with heart failure background
C Tunca, F Oguz, B Ozlek, V,O TanikAbstract
Abstract
Right ventricular–pulmonary arterial (RV–PA) coupling is a major determinant of outcomes in heart failure. The TAPSE/sPAP ratio provides a simple, non-invasive estimate of RV–PA coupling and has demonstrated prognostic value across heart failure phenotypes. However, its role in patients treated with cardiac resynchronization therapy (CRT), in whom left-sided mechanical improvement may be offset by right ventricular dysfunction, remains insufficiently defined.
Purpose
To evaluate whether baseline TAPSE/sPAP independently predicts 1-year all-cause mortality in patients with heart failure undergoing CRT and to assess its incremental prognostic value beyond conventional clinical and echocardiographic parameters.
Methods
This retrospective cohort study included 350 consecutive patients with heart failure with reduced ejection fraction (LVEF ≤35%) who underwent cardiac resynchronization therapy. Baseline transthoracic echocardiography was used to assess tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio was calculated as a non-invasive measure of right ventricular–pulmonary arterial coupling. Patients were stratified according to a TAPSE/sPAP cut-off value of 0.36. The primary endpoint was 1-year all-cause mortality. Survival was analyzed using Kaplan–Meier methods and compared with the log-rank test. Cox proportional hazards regression analysis was performed to identify independent predictors of mortality.
Results
During 12-month follow-up, 46 deaths occurred (13.1%). Patients with reduced TAPSE/sPAP exhibited higher congestion burden and adverse biomarker profiles. Using a prespecified threshold of 0.36 mm/mmHg, 1-year mortality was significantly higher in patients with TAPSE/sPAP <0.36 compared with those ≥0.36 (24.4% vs 8.1%; log-rank p<0.001). After multivariable adjustment, TAPSE/sPAP <0.36 independently predicted 1-year mortality (HR 2.58, 95% CI 1.52–4.39; p<0.001) and provided incremental prognostic value beyond conventional CRT-related predictors, improving model discrimination (ΔC-index +0.04; p=0.01).
Conclusion
In CRT-treated heart failure patients, baseline TAPSE/sPAP is a strong and independent predictor of 1-year mortality and adds prognostic information beyond traditional clinical, electrical, and left ventricular parameters. Incorporation of TAPSE/sPAP into routine assessment may facilitate early identification of high-risk patients, guide post-CRT surveillance intensity, and refine long-term risk stratification.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.