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Can TAPSE/PSAP ratio predict mortality and re-hospitalization in acute heart failure patients?
Session:
Painel 1 - Insuficiência Cardíaca 9
Speaker:
Carolina Saleiro
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Carolina Saleiro; Diana Decampos; Rogerio Teixeira; João Lopes; José Pedro Sousa; Luís Puga; Joana M. Ribeiro; Ana Rita M. Gomes; Santinha Maria Lurdes Quefi; Carolina Lourenço; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background:</strong> TAPSE/PSAP ratio was proposed as a possible index of the right ventricular (RV) length-force relationship. In small studies, a reduced ratio was associated with decreased survival. However, the prognostic impact of this ratio in acute heart failure (HF) patients is unclear.</p> <p><strong>Aim: </strong>To assess the impact of the TAPSE/PSAP ratio on all-cause mortality and rehospitalization in acutely decompensated heart failure (ADHF) patients.</p> <p><strong>Methods: </strong>One hundred-six patients (82% male, mean age: 69±15 years) consecutively admitted to a single care unit due to ADHF were included. Clinical, laboratorial and echocardiographic data were evaluated. The primary endpoint was all-cause mortality and the secondary endpoint was a combined outcome of all-cause mortality and HF rehospitalization. ROC analysis was used to determine the ability of the TAPSE/PSAP ratio to identify patients who met the primary outcome. A cut-off value to predict the outcome was derived from the Youden index and two groups were created based on this cut-off. Kaplan-Meyer survival curves and multivariate Cox regression were conducted to evaluate the impact of the ratio on both endpoints. The mean follow-up was 32±24 months.</p> <p><strong>Results</strong>: Ischemic cardiomyopathy (28%) was the most common aetiology and a minority (18%) had preserved left ventricular ejection fraction (LVEF). The majority (52%) was admitted at NHYA IV class. Mean TAPSE was 15±4mm; PSAP 45±15mmHg and TAPSE/PSAP ratio 0.38±0.17mm/mmHg. 40 patients met the primary endpoint and 65 the secondary endpoint. The area under the curve for the TAPSE/PSAP ratio was 0.614 (95% CI 0.51-0.71, <em>P<0.05</em>) and the associated criterion was 0.33. Fifty-two patients had a ratio ≥0.33mm/mmHg. Kaplan-Meyer curves showed different event free survival among groups - TAPSE/PSAP ≥0.33 vs <0.33mm/mmHg - (69% vs 43%, Log Rank <em>P=0.01 – Figure 1</em>) for all-cause mortality and (47% vs 24%, Log Rank <em>P<0.01 – Figure 2) </em>for the composite outcome. In a model adjusted for age, LVEF groups and admission NT-proBNP, a TAPSE/PSAP ratio <0.33mm/mmHg remained associated with the primary (HR 3.30, 95% CI 1.60-6.77, <em>P=0.001</em>) and the secondary endpoints (HR 2.64, 95% CI 1.53-4.46, <em>P<0.001</em>).</p> <p><strong>Conclusion: </strong>According to our data the TAPSE/PASP ratio seems to be an useful prognosis predictor in ADHF.</p>
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