Tricuspid Annular Plane Systolic Excursion/Pulmonary Arterial Systolic Pressure Ratio as a Predictor of Mortality in Heart Failure Patients
Abdessamad Couissi *
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Taha Ettachfini
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Mehdi Rochd
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Anass Maaroufi
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Meryem Haboub
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
Rachida Habbal
Department of Cardiology, IBN ROCHD University Hospital, Casablanca, Morocco and Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Aims: We aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in Moroccan patients with heart Failure (HF).
Study Design: A retrospective study was conducted in The Cardiology Department of Ibn Rochd Hospital of Casablanca in Morocco. The study was conducted in the period between March 2012 to March 2016 with a follow-up until December 2022.
Methods: data were evaluated from the HF register patients and their relatives were contacted by phone. Patients with reduced LVEF were included, patients with pulmonary embolism, and patients with HFpEF were excluded. The endpoint of the study was mortality.
Results: 128 patients were enrolled Over an average follow-up of 58 months. 51(41.4%) patients died at the end of the follow-up, the median value of left ventricular ejection fraction was 35.2 ± 2.2%. Patients were stratified according to the TAPSE/PASP ratio (low <0.32 mm/mmHg; high: >0.32 mm/mmHg). Kaplan-Meier survival analysis showed that ten-year all-cause mortality was significantly higher in patients with TAPSE/PASP ≤0.32 mm/mmHg than in patients with TAPSE/PASP > 0.32 mm/mmHg (log-rank 7.8, p =0.008) Cox regression analysis revealed that lower LVEF (p= 0.04), and a ratio of TAPSE\PAPS <0.32 (p=0.02) were associated to an increase in all-cause mortality.
Conclusion: Correlating right ventricular function to loading conditions may be more accurate in assessing its real contractility and predicting patients’ outcomes. Our study showed that TAPSE/PASP appears as a novel prognostic predictor in patients with Heart failure.
Keywords: TAPSE, PASP, Chronic heart failure, Morocco, predictors, mortality
How to Cite
References
Global burden of heart failure: a comprehensive and updated review of epidemiology - PubMed [Internet].
[Access on 2023 Aug 9]. Available:https://pubmed.ncbi.nlm.nih.gov/35150240/
AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation [Internet]; 2022.
[Access on 2023 Aug 15] Available:https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001063
Rigolin VH, Robiolio PA, Wilson JS, Harrison JK, Bashore TM. The forgotten chamber: the importance of the right ventricle. Cathet Cardiovasc Diagn. 1995; 35(1):18–28.
Right Ventricular Function in Cardiovascular Disease, Part I | Circulation [Internet].
[Access on 2023 Aug 15] Available:https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.107.653576#d1e746
Sert S, Selçuk N, Yıldırımtürk Ö, Orhan G. Prognostic value of TAPSE/PASP ratio in right ventricular failure after left ventricular assist device implantation: Experience from a tertiary center. Turk J Thorac Cardiovasc Surg. 2022;30(3):334–43.
Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart. 2006;92 Suppl 1(Suppl 1):i2-13. DOI: 10.1136/hrt.2005.077875. PMID: 16543598; PMCID: PMC1860731
He Q, Lin Y, Zhu Y, Gao L, Ji M, Zhang L, et al. Clinical usefulness of right ventricle–pulmonary artery coupling in cardiovascular disease. J Clin Med. 2023; 12(7):2526.
Tello K, Wan J, Dalmer A, Vanderpool R, Ghofrani HA, Naeije R, et al. Validation of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio for the assessment of right ventricular-arterial coupling in severe pulmonary hypertension. Circ Cardiovasc Imaging. 2019;12(9):e009047.
Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol. 2013;305(9):H1373-1381.
Naseem M, Alkassas A, Alaarag A. Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of in-hospital mortality for acute heart failure. BMC Cardiovasc Disord. 2022;22(1):414.
Iacoviello M, Monitillo F, Citarelli G, Leone M, Grande D, Antoncecchi V, et al. Right ventriculo-arterial coupling assessed by two-dimensional strain: A new parameter of right ventricular function independently associated with prognosis in chronic heart failure patients. Int J Cardiol. 2017; 241:318–21.
Angaran P, Dorian P, Ha ACT, Thavendiranathan P, Tsang W, Leong-Poi H, et al. Association of left ventricular ejection fraction with mortality and hospitalizations. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr. 2020; 33(7):802-811.e6.
Solomon SD, Anavekar N, Skali H,et al ; Candesartan in Heart Failure Reduction in Mortality (CHARM) Investigators. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation. 2005; 112(24):3738-44.
DOI:10.1161/CIRCULATIONAHA.105.561423. Epub 2005 Dec 5. PMID: 16330684
Packer M. What causes sudden death in patients with chronic heart failure and a reduced ejection fraction? Eur Heart J. 2020 May 7;41(18):1757-1763. DOI:10.1093/eurheartj/ehz553.PMID:31390006; PMCID: PMC7205466
Bursi F, McNallan SM, Redfield MM, Nkomo VT, Lam CSP, Weston SA, et al. Pulmonary pressures and death in heart failure: a community study. J Am Coll Cardiol. 2012 Jan 17;59(3):222–31.
Kjaergaard J, Akkan D, Iversen KK, Køber L, Torp-Pedersen C, Hassager C. Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail. 2007;9(6–7): 610–6.