Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.
Int J Cardiovasc Imaging. 2024 Nov;40(11):2325-2334. doi: 10.1007/s10554-024-03233-5. Epub 2024 Sep 5.
The ratio between tricuspid annular plane systolic excursion (TAPSE) and estimated pulmonary artery systolic pressure (PASP) has been shown to be a reliable, non-invasive surrogate of the right ventricular-pulmonary artery (RV-PA) coupling. The present study analysed the association between TAPSE/PASP and response to cardiac resynchronization therapy (CRT) and the prognostic role of RV-PA in patients undergoing CRT implantation. The primary endpoints were: the association between baseline TAPSE/PASP and CRT response/cardiovascular and all-cause death.
All patients having undergone CRT implantation in our Center from 2016 to 2020 were included in our retrospective analysis. The RV-PA coupling was assessed by echocardiography at baseline and 1 year follow up in CRT recipients. The cut-off value of TAPSE/PASP resulted from ROC curve analysis (i.e.<0.33 mm/mmHg). A total of 229 patients (age 69.9 ± 10.1 years; 77.7% men) were included. During a mean follow-up of 44.2 ± 17.9 months, 40 (17.5%) patients died. The baseline value of TAPSE/PASP was not significantly associated with CRT response. Patients with a more impaired TAPSE/PASP ratio had significantly worse survival rates. On multivariate Cox regression, only TAPSE/PASP ratio and estimated glomerular filtration rate were independently associated with all-cause death. Finally, the TAPSE/PASP ratio significantly increased after CRT implantation in the group of "responders" whereas it did not change in 'non-responders'.
The baseline value of TAPSE/PASP ratio was not associated with CRT response. However, the TAPSE/PASP ratio was a strong predictor of both all-cause and cardiovascular death in CRT recipients.
三尖瓣环平面收缩期位移（TAPSE）与估计的肺动脉收缩压（PASP）的比值已被证明是右心室-肺动脉（RV-PA）耦联的可靠、非侵入性替代指标。本研究分析了 TAPSE/PASP 与心脏再同步治疗（CRT）反应之间的相关性，以及 RV-PA 在接受 CRT 植入患者中的预后作用。主要终点为：基线 TAPSE/PASP 与 CRT 反应/心血管和全因死亡之间的相关性。
我们的回顾性分析纳入了 2016 年至 2020 年在我们中心接受 CRT 植入的所有患者。在 CRT 接受者中，基线和 1 年随访时通过超声心动图评估 RV-PA 耦联。TAPSE/PASP 的截断值来自 ROC 曲线分析（即<0.33mm/mmHg）。共纳入 229 例患者（年龄 69.9±10.1 岁；77.7%为男性）。平均随访 44.2±17.9 个月期间，40 例（17.5%）患者死亡。TAPSE/PASP 的基线值与 CRT 反应无显著相关性。TAPSE/PASP 比值受损更严重的患者生存率显著更差。多变量 Cox 回归分析显示，只有 TAPSE/PASP 比值和估计肾小球滤过率与全因死亡独立相关。最后，在“应答者”组中，TAPSE/PASP 比值在 CRT 植入后显著增加，而在“非应答者”组中则没有变化。
TAPSE/PASP 比值的基线值与 CRT 反应无关。然而，TAPSE/PASP 比值是 CRT 接受者全因和心血管死亡的强有力预测指标。
