TAPSE/sPAP prognostic value for In-Hospital Adverse Events in Patients Hospitalized for Acute Coronary Syndrome
C. Fauvel
(1, 2, 3)
,
J. G. Dillinger
(4, 5)
,
C. Bouleti
(6, 7)
,
A. Trimaille
(8, 9)
,
C. Tron
(10, 3)
,
A. S. Chaussade
(11)
,
C. Thuaire
(12)
,
C. Delmas
(13)
,
A. Boccara
(14)
,
V. Roule
(15)
,
D. Millischer
(16)
,
E. Thevenet
(17)
,
C. Meune
(18, 19)
,
M. Stevenard
(20)
,
C. Charbonnel
(21)
,
L. M. Ballesteros
(22)
,
T. Pommier
(23)
,
A. El Ouahidi
(24)
,
F. Swedsky
(25)
,
D. Martinez
(26, 27)
,
M. Hauguel-Moreau
(28)
,
G. Schurtz
(29)
,
A. Coisne
(29)
,
V. Dupasquier
(30)
,
T. Bochaton
(31, 32)
,
E. Gerbaud
(33, 34)
,
E. Puymirat
(35)
,
P. Henry
(5, 4)
,
T. Pezel
(4, 36)
1
CHU Rouen
2 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
3 FHU Carnaval - FHU Cardiac Research Network on Aortic Valve and heart faiLure [Rouen]
4 Hôpital Lariboisière-Fernand-Widal [APHP]
5 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
6 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
7 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
8 Nouvel Hôpital Civil de Strasbourg
9 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
10 Service de Cardiologie [CHU Rouen]
11 Clinique A Paré [Neuilly]
12 Centre hospitalier de Chartres (Chartres)
13 Service Cardiologie [CHU Toulouse]
14 CHI André Gregoire - Centre Hospitalier Intercommunal André Grégoire [Montreuil]
15 CHU Caen
16 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
17 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
18 Hôpital Avicenne [AP-HP]
19 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
20 Hôpital d'instruction des Armées Percy
21 CHV - Centre Hospitalier de Versailles André Mignot
22 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
23 Service de Cardiologie [CHU de Dijon]
24 CCTV - Brest - Service de chirurgie thoracique et cardio vasculaire [Brest]
25 Centre Hospitalier Henri Duffaut (Avignon)
26 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
27 UM - Université de Montpellier
28 Hôpital Ambroise Paré [AP-HP]
29 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
30 CHU Montpellier = Montpellier University Hospital
31 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
32 Hôpital Louis Pradel [CHU - HCL]
33 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
34 Hôpital Haut-Lévêque [CHU Bordeaux]
35 HEGP - Hôpital Européen Georges Pompidou [APHP]
36 UPCité - Université Paris Cité
2 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
3 FHU Carnaval - FHU Cardiac Research Network on Aortic Valve and heart faiLure [Rouen]
4 Hôpital Lariboisière-Fernand-Widal [APHP]
5 MASCOT (UMR_S_942 / U942) - Marqueurs cardiovasculaires en situation de stress
6 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
7 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
8 Nouvel Hôpital Civil de Strasbourg
9 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
10 Service de Cardiologie [CHU Rouen]
11 Clinique A Paré [Neuilly]
12 Centre hospitalier de Chartres (Chartres)
13 Service Cardiologie [CHU Toulouse]
14 CHI André Gregoire - Centre Hospitalier Intercommunal André Grégoire [Montreuil]
15 CHU Caen
16 Groupe Hospitalier Intercommunal Le Raincy-Montfermeil
17 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
18 Hôpital Avicenne [AP-HP]
19 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
20 Hôpital d'instruction des Armées Percy
21 CHV - Centre Hospitalier de Versailles André Mignot
22 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
23 Service de Cardiologie [CHU de Dijon]
24 CCTV - Brest - Service de chirurgie thoracique et cardio vasculaire [Brest]
25 Centre Hospitalier Henri Duffaut (Avignon)
26 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
27 UM - Université de Montpellier
28 Hôpital Ambroise Paré [AP-HP]
29 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
30 CHU Montpellier = Montpellier University Hospital
31 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
32 Hôpital Louis Pradel [CHU - HCL]
33 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
34 Hôpital Haut-Lévêque [CHU Bordeaux]
35 HEGP - Hôpital Européen Georges Pompidou [APHP]
36 UPCité - Université Paris Cité
Résumé
AIMS: Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study. METHODS AND RESULTS: 481 consecutive patients hospitalized in intensive cardiac care unit (mean age 65±13 years, 73% of male, 46% STEMI) for ACS (either ST-elevation [STEMI] or non-ST-elevation [NSTEMI] myocardial infarction) with TAPSE/sPAP available were included in this prospective French multicentric study (39 centers). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 33 (7%) patients. ROC-curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP \textless0.55 was associated with in-hospital MACEs, even after adjustment with comorbidities (OR:19.1, 95%CI[7.78-54.8]), clinical severity including left ventricular ejection fraction (OR:14.4, 95%CI[5.70-41.7]) and propensity-matched population analysis (OR:22.8, 95%CI[7.83-97.2], all p\textless0.001). After adjustment, TAPSE/sPAP \textless0.55 showed the best improvement in model discrimination and reclassification above traditional prognosticators (C-statistic improvement: 0.16; global chi-square improvement: 52.8; LR-test p\textless0.001) with similar results for both STEMI and NSTEMI subgroups. CONCLUSION: A low RV-PA coupling defined as TAPSE/sPAP ratio \textless0.55 was independently associated with in-hospital MACEs and provided incremental prognostic value over traditional prognosticators in patients hospitalized for ACS. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05063097.