Objective: Right ventricular (RV)-pulmonary circulation (PC) uncoupling is associated with poor outcome in patients with Heart Failure with Preserved Ejection Fraction (HFpEF). Tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio is simple echo-derived indicator of RV-PC uncoupling. This study aimed to investigate the prognostic impact of TAPSE/PASP ratio among patients with HFpEF hospitalized for acute heart failure (AHF).
Methods: Single-centre, retrospective study including patients hospitalized for AHF over a 4-year period. Receiver operating character (ROC) curves for the TAPSE/PASP ratio were used to identify the cut-off value for the composite outcome of all-cause in-hospital mortality and hospital readmission.
Results: Overall, 398 patients were included (median age 83 years, 56.0% females). According to ROC curve analysis, we calculated an ideal cut-off of 0.36 mm/mmHg for TAPSE/PASP ratio. Patients were divided into two categories, preserved RV-PC coupling (TAPSE/PASP ratio > 0.36) and RV-PC uncoupling (TAPSE/PASP ratio ≤ 0.36). Overall, both in-hospital mortality and readmission rate were higher among HFpEF patients with TAPSE/PASP ratio ≤ 0.36 compared to those with TAPSE/PASP ratio > 0.36 (31.4 % vs 20.3%; p = 0.008). At multivariate analysis, TAPSE/PASP ratio ≤ 0.36 emerged as an independent risk factor both for death (HR 2.18 [1.08 - 4.42]; p = 0.03) and the composite outcome (HR 1.95 [1.22 - 3.12]; p = 0.005).
Conclusion: Among patients with HFpEF and hospitalized for AHF, the RV-PC uncoupling was associated with a more than two-fold increased risk of in-hospital mortality.
Keywords: Acute heart failure; Heart failure with preserved ejection fraction; Right ventricular dysfunction; TAPSE/PASP ratio.
Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.