Ann Med. 2026 Dec;58(1):2705685. doi: 10.1080/07853890.2026.2705685. Epub 2026 Jul 21.
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.
PMID:42480114 | DOI:10.1080/07853890.2026.2705685