The predictive value of the TAPSE/PASP ratio for major adverse cardiovascular events in patients with chronic heart failure: evidence from a prolonged follow-up cohort
TL;DR
Lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes and may provide complementary prognostic information, but its clinical utility requires prospective external validation.
Abstract
Abstract Background The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a noninvasive surrogate of right ventricular–pulmonary arterial coupling. Previous evidence focused mainly on in-hospital, 90-day, or 1-year outcomes; long-term prognostic value across heart failure phenotypes remains unclear. Methods This cohort included 440 chronic heart failure patients admitted between 2019 and 2021. Median age was 67 years; 31.1% were female; median follow-up was 41 months. Restricted cubic spline analysis assessed association between TAPSE/PASP and major adverse cardiovascular events (MACEs), defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, or heart failure rehospitalization. Kaplan–Meier and multivariable Cox regression analyses evaluated associations. Incremental value was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results During follow-up, 193 patients experienced MACEs. TAPSE/PASP showed an approximately linear inverse association with MACE risk, with an exploratory cut-off of 0.036. After adjustment including natriuretic peptides, each 0.01-unit increase in TAPSE/PASP was associated with lower MACE risk (HR 0.75, 95% CI 0.66–0.87; p = 6.02 × 10−5), whereas TAPSE/PASP ≤0.036 was associated with higher risk (HR 1.98, 95% CI 1.37–2.85; p = 2.57 × 10−4). Adding TAPSE/PASP modestly improved discrimination (C-statistic 0.80 vs. 0.77), reclassification (NRI 0.31), and IDI (0.04) (all p < 0.05). Associations were consistent across prespecified subgroups. Conclusions In chronic heart failure patients, lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes. TAPSE/PASP may provide complementary prognostic information, but its clinical utility requires prospective external validation.