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Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure prognostic value for in-hospital adverse events in patients hospitalized for acute coronary syndrome

2024; Oxford University Press; Volume: 25; Issue: 9 Linguagem: Inglês

10.1093/ehjci/jeae110

2047-2412

Charles Fauvel, Jean‐Guillaume Dillinger, Claire Bouleti, Antonin Trimaille, Christophe Tron, Anne Solène Chaussade, Christophe Thuaire, Clément Delmas, Claude Boccara, Vincent Roule, Damien Millischer, Eugénie Thevenet, Christophe Meune, Mathilde Stevenard, C. Charbonnel, Laura Maitre Ballesteros, Thibaut Pommier, Amine El Ouahidi, Fédérico Swedsky, D. Rodríguez Martínez, Marie Hauguel‐Moreau, Guillaume Schurtz, Augustin Coisne, Valentin Dupasquier, Thomas Bochaton, Édouard Gerbaud, Étienne Puymirat, Patrick Henry, Théo Pezel, Aboyans Victor, Albert Emeric, A. Franck, A Diehl Sean, Ayman Mohamed Nabil, Andrieu Stéphane, Attou Sabir, Auvray Simon, Azzakani Sonia, Azencot Ruben, Bedossa Marc, Boccara Franck, B Albert, Bochaton Thomas, B Eric, Bonnet Guillaume, Bonnet Guillaume, Bouali Nabil, Océane Bouchot, Bouleti Claire, Boukertouta Tanissia, Baptiste Brette Jean, Canu Marjorie, Chaib Aures, Charbonnel Clement, Solene Chaussade Anne, C Alexandre, Cottin Yves, Darmon Arthur, De Angelis Elena, Clément Delmas, Delsarte Laura, Deney Antoine, Claude Dib Jean, Dillinger Jean‐Guillaume, Docq Clemence, Dupasquier Valentin, Meyer Elbaz, El Hadad Antony, El Ouahidi Amine, Ezzouhairi Nacim, Fabre Julien, Fard Damien, Fauvel Charles, Gerbaud Édouard, Martine Gilard, Goralski Marc, Grinberg Nissim, Grentzinger Alain, Hauguel-Moreau Marie, Patrick Henry, Huet Fabien, Landemaine Thomas, Benoît Lattuca, L A Leo, Levasseur Thomas, Lim Pascal, Maitre Ballesteros Laura, Mansencal Nicolas, M Benjamin, M Radosevich David, Merat Benoit, Meune Christophe, Millischer Damien, Moine Thomas, Nhan Pascal, N. Nathalie, Patrick Ohlmann, Pezel Théo, Picard Fabien, Piliero Nicolas, Pommier Thibaut, Étienne Puymirat, R. Martin Arthur, Rossanaly Vasram Reza, François Roubille, Roule Vincent, Schurtz Guillaume, S. Mathilde, Sulman David, Swedsky Fédérico, Tea Victoria, Thevenet Eugénie, Thuaire Christophe, Trimaille Antonin, Tron Christophe, Viboud Guillaume, Yomi Dominique, Zakine Cyril,

Ultrasound in Clinical Applications

Abstract Aims Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study. Methods and results A total of 481 consecutive patients hospitalized in intensive cardiac care unit [mean age 65 ± 13 years, 73% of male, 46% ST-elevation myocardial infarction (STEMI)] for ACS [either STEMI or non-STEMI (NSTEMI)] with TAPSE/sPAP available were included in this prospective French multicentric study (39 centres). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest, or cardiogenic shock and occurred in 33 (7%) patients. Receiver operating characteristic curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP <0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities [odds ratio (OR): 19.1, 95% confidence interval (CI) 7.78–54.8], clinical severity including left ventricular ejection fraction (OR: 14.4, 95% CI 5.70–41.7), and propensity-matched population analysis (OR: 22.8, 95% CI 7.83–97.2, all P < 0.001). After adjustment, TAPSE/sPAP <0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global χ2 improvement: 52.8; likelihood ratio test P < 0.001) with similar results for both STEMI and NSTEMI subgroups. Conclusion A low RV-PA coupling defined as TAPSE/sPAP ratio <0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS. Trial Registration ClinicalTrials.gov Identifier: NCT05063097