https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Würzburg Deutsches Zentrum für Herzinsuffizienz/DZHI Würzburg, Deutschland; 2Universitätsklinikum Würzburg Service Center Medical Informatics Würzburg, Deutschland; 3Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland
Background & Purpose: The coupling of right ventricular (RV) function and pulmonary circulation is increasingly recognized as a critical factor in the prognosis of patients with heart failure (HF). It can be studied using the ratio of the tricuspid annular plane systolic excursion (TAPSE) and the pulmonary artery systolic pressure (PASP). We investigated the TAPSE/PASP ratio in patients hospitalized with acute heart failure (AHF) according to left ventricular ejection fraction (LVEF) categories.
Methods: Between 2015 and 2020, a total of 1000 AHF patients were included in a prospective registry at a University center. TAPSE was measured by M-Mode when tracing the lateral tricuspid annulus during transthoracic echocardiography (TTE). PASP was obtained by assessing the maximum tricuspid valve regurgitation gradient and adding the right atrial pressure estimated based on vena cava width and collapsibility. Patients with valid 1-year follow-up information were enrolled in the present analysis. Patients were classified according to LVEF categories: ≤30%, 31-40%, 41-49%, 50-65%, and >65%. To estimate the prognostic utility, Cox proportional hazards regression models were used.
Results: In total, 930 patients (74±11 years, 40% women, LVEF 47±16%) entered the analysis. Within one year, 217 patients (23%) had died. Patients in lower LVEF categories were younger, more often men, and had higher levels of NT-proBNP (Table). The TAPSE/PASP ratio increased with higher LVEF categories. Crude 1-year mortality was not different between LVEF categories (Table). In age- and sex-adjusted Cox regression addressing the total sample, a higher TAPSE/PASP ratio was a strong predictor of lower 1-year mortality risk: HR per mm/mmHg 0.12, 95%CI 0.05–0.28, p<0.001. Yet, there was an interaction with LVEF: in further analyses stratified by LVEF categories, the prognostic utility of the TAPSE/PASP ratio was refined to patients with LVEF ≤30% (HR 0.13, 95%CI 0.02–0.91, p=0.04), or LVEF 50–65% (HR 0.12, 95%CI 0.03–0.51, p=0.04), or LVEF >65% (HR 0.05, 95%CI 0.01–0.42, p=0.006).
Conclusion: In patients hospitalized with AHF, we found concurrent impairment of RV function across all LVEF categories. RV-pulmonary arterial coupling was a critical predictor of 1-year mortality in AHF patients with severely reduced LVEF as well as in those with preserved LVEF. Our findings suggest to integrate RV functional parameters in the risk assessment of AHF patients, especially in those with normal and supranormal LVEF.