One-year prognostic value of right ventricular to pulmonary arterial coupling among patients hospitalized for acute coronary syndrome: Insights from the ADDICT-ICCU study - 16/01/25
, N. El Beze 2, G. Schurtz 3, J.C. Dib 4, C. Delmas 5, C. Bouleti 6, V. Roule 7, A. Boccara 8, A. Trimaille 9, F. Boccara 10, S. Toupin 11, J.-G. Dillinger 12, P. Henry 12, T. Pezel 13, C. Fauvel 14Résumé |
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.
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Vol 118 - N° 1S
P. S8-S9 - janvier 2025 Retour au numéro
Article précédent
- Comparison of angiography-derived index of microcirculatory resistance measurements between low and high frame-rate acquisitions: The prospective ADMIRAL-study
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