Riccardi Mauro, Pagnesi Matteo, Corso Rossana, Sammartino Antonio M, Tomasoni Daniela, Inciardi Riccardo M, Lombardi Carlo M, Adamo Marianna, Nodari Savina, Metra Marco
Department of Medical and Surgical Specialties, Radiological Science and Public Health, Institute of Cardiology, ASST Spedali Civili, University of Brescia, Brescia, Italy.
Department of Internal Medicine, ASST Sette Laghi, Varese, Italy.
ESC Heart Fail. 2025 Apr;12(2):912-922. doi: 10.1002/ehf2.15139. Epub 2024 Dec 24.
Few data are available regarding the role of tricuspid annulus plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP), a measurement of right ventricular to pulmonary artery coupling, in patients with chronic heart failure and left ventricular systolic dysfunction.
This retrospective single-centre study included outpatients with left ventricular systolic dysfunction (ejection fraction ≤ 50%) evaluated between January 2022 and December 2022. TAPSE/PASP was evaluated as a continuous variable and as tertiles according to its value on the first visit. The primary outcome of the study was a composite of all-cause mortality or heart failure (HF) events at the last available follow-up.
A total of 642 patients were included (mean age 71 ± 13 years, 78% male, mean left ventricular ejection fraction 40% [interquatile range 35-46]). Patients with lower TAPSE/PASP had more co-morbidities (i.e., atrial fibrillation, chronic kidney disease or previous cardiovascular implantable electronic device), an higher New York Heart Association class (P < 0.001), more signs of congestion (P = 0.007), and had more probability to receive intravenous furosemide during the visit (P < 0.001). After a median follow-up of 474 days [interquartile range 392-507 days], a total of 51 patients (8.0%) died (with 24 patients [3.8%] experiencing cardiovascular-related deaths), a total of 179 patients (28.1%) experienced a composite outcome, and 158 patients (24.8%) had HF events. Kaplan-Meier analysis showed that the estimated 1-year rate of the primary outcome was higher in the lowest tertile (38.0%), as compared with the intermediate (19.6%) and highest tertiles (14.9%; P-value log-rank <0.001). TAPSE/PASP ratio as a continuous variable was independently associated with the primary outcome (adjusted hazard ratio for 0.1 mm/mmHg increase 0.91, 95% CI 0.84-0.98, P = 0.009), predominantly driven by a higher risk of HF events during follow-up. Analysing the impact of TAPSE/PASP tertiles on the primary outcome, an independent associated was confirmed at multivariate analisys for the highest versus lowest tertile (adjusted hazard ratio 0.61, 95% CI 0.38-0.99, P = 0.044).
TAPSE/PASP was independently associated with mortality or HF events among ambulatory patients with left ventricular systolic dysfunction.
关于三尖瓣环平面收缩期位移与肺动脉收缩压比值（TAPSE/PASP）这一右心室与肺动脉耦合的测量指标，在慢性心力衰竭和左心室收缩功能障碍患者中的作用，目前可用数据较少。
这项回顾性单中心研究纳入了2022年1月至2022年12月期间评估的左心室收缩功能障碍（射血分数≤50%）的门诊患者。TAPSE/PASP被评估为连续变量，并根据首次就诊时的值分为三分位数。研究的主要结局是最后一次可用随访时的全因死亡率或心力衰竭（HF）事件的复合结局。
共纳入642例患者（平均年龄71±13岁，78%为男性，平均左心室射血分数40%[四分位数间距35 - 46]）。TAPSE/PASP较低的患者合并症更多（即心房颤动、慢性肾脏病或既往植入心血管植入式电子设备），纽约心脏协会心功能分级更高（P<0.001），充血体征更多（P = 0.007），且在就诊期间接受静脉注射呋塞米的可能性更大（P<0.001）。中位随访474天[四分位数间距392 - 507天]后，共有51例患者（8.0%）死亡（24例患者[3.8%]发生心血管相关死亡），共有179例患者（28.1%）出现复合结局，158例患者（24.8%）发生HF事件。Kaplan-Meier分析显示，最低三分位数组的主要结局估计1年发生率较高（38.0%），而中间三分位数组（(19.6%）和最高三分位数组（14.9%；对数秩检验P值<0.001）较低。TAPSE/PASP比值作为连续变量与主要结局独立相关（每增加0.1mm/mmHg的调整后风险比为0.91，95%置信区间0.84 - 0.98，P = 0.009），主要是由于随访期间HF事件风险较高所致。分析TAPSE/PASP三分位数对主要结局的影响，在多变量分析中证实最高三分位数与最低三分位数相比存在独立相关性（调整后风险比0.61，95%置信区间0.38 - 0.99，P = 0.044）。
在左心室收缩功能障碍的门诊患者中，TAPSE/PASP与死亡率或HF事件独立相关。
