Revista espanola de cardiologia (English ed.) · 2025
Right ventricular-pulmonary arterial coupling as a predictor of death or heart failure admission in patients with severe tricuspid regurgitation.
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Fernández Ruiz Ana, Ruiz Ortiz Martín, Fernández-Avilés Irache Consuelo, Rodríguez Almodóvar Ana María, Delgado Ortega Mónica, Esteban Martínez Fátima, Resúa Collazo Adriana, Heredia Campos Gloria, González Manzanares Rafael, López Aguilera José, Castillo Domínguez Juan Carlos, Anguita Sánchez Manuel, Pan Álvarez-Ossorio Manuel, Mesa Rubio Dolores
Аннотация
INTRODUCTION AND OBJECTIVES: The right ventricular-pulmonary arterial coupling, evaluated by tricuspid annular plane systolic excursion and pulmonary artery systolic pressure ratio (TAPSE/PASP), has been studied in the prognostic assessment of severe tricuspid regurgitation only in selected populations and mainly in relation to all-cause mortality.
METHODS: We retrospectively included all adult patients with severe tricuspid regurgitation who underwent echocardiography at a tertiary care hospital between January 1, 2008, and December 31, 2017. We investigated the association of TAPSE/PASP, either as a continuous variable or dichotomized at <0.31mm/mmHg, with the combined endpoint of mortality and heart failure (HF) admission, as well as its usefulness in several subgroups of interest.
RESULTS: A total of 474 patients (70±13 years; 71% women) were included, with a median follow-up of 5 [p25-75, 2-7] years. During follow-up, 285 patients died and 192 experienced 481 HF admissions. Patients with TAPSE/PASP <0.31mm/mmHg had significantly worse HF admission-free survival at median follow-up (25% vs 53%, P <.0005). The discriminative ability of TAPSE/PASP was statistically significant (area under the curve, 0.69; 95%CI, 0.65-0.74; P <.0005). After multivariate adjustment, TAPSE/PASP remained an independent predictor of the combined endpoint (HR, 0.017; 95%CI, 0.004-0.075; P <.0005), with significant incremental prognostic value over clinical variables (P <.0005). The performance of the index was consistent in patients with pacemaker/defibrillator leads or prior cardiac surgery, but not in those with reduced ejection fraction.
CONCLUSIONS: In this cohort of patients with severe tricuspid regurgitation, TAPSE/PASP was a strong independent predictor of HF admission or mortality during long-term follow-up.
METHODS: We retrospectively included all adult patients with severe tricuspid regurgitation who underwent echocardiography at a tertiary care hospital between January 1, 2008, and December 31, 2017. We investigated the association of TAPSE/PASP, either as a continuous variable or dichotomized at <0.31mm/mmHg, with the combined endpoint of mortality and heart failure (HF) admission, as well as its usefulness in several subgroups of interest.
RESULTS: A total of 474 patients (70±13 years; 71% women) were included, with a median follow-up of 5 [p25-75, 2-7] years. During follow-up, 285 patients died and 192 experienced 481 HF admissions. Patients with TAPSE/PASP <0.31mm/mmHg had significantly worse HF admission-free survival at median follow-up (25% vs 53%, P <.0005). The discriminative ability of TAPSE/PASP was statistically significant (area under the curve, 0.69; 95%CI, 0.65-0.74; P <.0005). After multivariate adjustment, TAPSE/PASP remained an independent predictor of the combined endpoint (HR, 0.017; 95%CI, 0.004-0.075; P <.0005), with significant incremental prognostic value over clinical variables (P <.0005). The performance of the index was consistent in patients with pacemaker/defibrillator leads or prior cardiac surgery, but not in those with reduced ejection fraction.
CONCLUSIONS: In this cohort of patients with severe tricuspid regurgitation, TAPSE/PASP was a strong independent predictor of HF admission or mortality during long-term follow-up.