One-year prognostic value of right ventricular to pulmonary arterial coupling among patients hospitalized for acute coronary syndrome: Insights from the ADDICT-ICCU study

Abstract

Introduction

Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography is a good non-invasive approach for right ventricular to pulmonary artery (RV-PA) coupling assessment. Although the prognostic value of this ratio is well known in many cardiovascular diseases, its prognostic value in acute coronary syndrome (ACS) is not established.

Objective

To assess one-year prognostic value of TAPSE/sPAP among patients hospitalised for ACS.

Method

In the prospective multicentric ADDICT-ICCU study, all consecutive patients hospitalized for ACS over two weeks in April 2021 at 39 centres across France were included. The TAPSE/sPAP ratio was measured using the first echocardiography performed within the first 24 hours of hospitalisation. The primary composite outcome was one-year major adverse cardiovascular event (MACE) including: all-cause death or urgent hospitalisation for acute cardiovascular reason (acute heart failure, urgent myocardial revascularisation). C-tree analysis was used to find the optimal TAPSE/sPAP cut-off to predict the primary outcome.

Results

Among the 772 ACS patients (age 64 ± 12 years, 74% males) included, 113 (15%) experienced 1-year MACE. The best cut-off for TAPSE/sPAP to predict 1-year MACE was 0.67 mm/mmHg. Patients with TAPSE/Spap ≤ 0.67 mm/mmHg were more likely older (p < 0.001), with previous atrial fibrillation (p < 0.001), a higher length of hospitalization in ICCU (p < 0.001), a higher NTproBNP (p = 0.001) and a worse LVEF value (p < 0.001). At one-year, all-cause death occurred in 27 (24%) patients with TAPSE/sPAP ≤ 0.67, compared to 7 (6%) with TAPSE/Spap > 0.67 (p < 0.001), and 32 (28%) patients with TAPSE/sPAP ≤ 0.67 were hospitalised for acute cardiovascular reason against 20 (18%) with TAPSE/sPAP > 0.67 (p = 0.006). After adjustment for all traditional prognosticators, grouped in models, TAPSE/sPAP < 0.67 mm/mmHg remained independently associated with the primary outcome: model 1 (comorbidities): HR 2.82, 95% CI [2.92–4.38], p < 0.001, model 2 (echocardiography): HR = 2.38, 95% CI [1,40–4,03], p < 0.001). Fig. 1 shows that patients with TAPSE/sPAP ≤0.67 mm/mmHg had worse event-free survival for the primary outcome: HR = 2.92, 95% CI [1.98–4.29], p < 0.001).

Conclusion

TAPSE/sPAP was independently associated with 1-year MACE in patients hospitalised for ACS, even after adjustment with traditional prognosticators, including LVEF.