Prognostic value of TAPSE/sPAP ratio among patients hospitalized in ICCU for acute cardiovascular event: Insights from the ADICCT-ICCU trial

Tricuspid annular plane systolic excursion divided by systolic pulmonary arterial pressure (TAPSE/sPAP), a noninvasive echocardiographic parameter to assess right ventricular to pulmonary arterial coupling, has already showed its prognostic significance in several cardiovascular diseases. Yet, it has never been assessed in intensive cardiac care unit (ICCU). To evaluate the prognostic value of TAPSE/sPAP ratio among patients hospitalized in ICCU for an acute cardiovascular event. From the ADICT-ICCU trial, patients with an early echocardiography performed within the first 24 hours of hospitalization with TAPSE/sPAP measurement were included. The primary outcome was in-hospital major adverse cardiac events (MAEs) defined by death, resuscitated cardiac arrest or cardiogenic shock. Among the 1499 consecutive patients screened, n = 907 were included (age 64 ± 15, 70% male). Sixty-two patients (6.8%) reached the primary outcome. Higher the NTproBNP, the diastolic dysfunction, the left ventricular end-diastolic volume, the left atrial volume, lower the TAPSE/sPAP (p < 0.001). In multivariable logistic regression analysis, TAPSE/sPAP was associated with MAEs even after adjustment for: cardiovascular comorbidities (OR = 0.01, 95%CI 0.00–0.05), echocardiography parameters including left ventricular ejection fraction (OR = 0.02, 95%CI 0.00–0.13), clinical severity at admission (OR = 0.02, 95%CI 0.00–0.10), biomarkers (OR = 0.03, 95%CI 0.00–0.17, all p < 0.001). Receiver operating characteristic curve analysis found 0.51 mm/mmHg as the best threshold. Using a propensity score adjustment, TAPSE/sPAP remained associated with MAEs (OR = 0.04, 95%CI 0.01–0.15, p < 0.001) (Table 1). TAPSE/sPAP ratio was independently associated with MAEs among patients hospitalized in ICCU suggesting its interest to stratify in-hospital patients’ prognosis.